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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004205
Report Date: 12/15/2023
Date Signed: 12/15/2023 11:14:37 AM

Document Has Been Signed on 12/15/2023 11:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:TOTAL CARE RESIDENTALFACILITY NUMBER:
306004205
ADMINISTRATOR:NORLAN MACHADOFACILITY TYPE:
735
ADDRESS:20220 MAPESTELEPHONE:
(562) 229-1999
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 4CENSUS: 4DATE:
12/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Erika FregosoTIME COMPLETED:
11:19 AM
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Licensing Program Analyst (LPA) Alberto Lopez conducted a Plan of Correction (POC) visit. LPA met with Ericka Fregoso, staff who assisted with the visit. LPA spoke with Administrator of record Mr Machado via phone who authorized staff Erika Fregoso to sign report. On 12/05/2023, LPA Lopez issued deficiency regarding Reporting Requirements.

Deficiency cited under 80061(b)(1)e) Reporting Requirements was due December 08, 2023, and has not been cleared by facility.


The administrator will read section 80061(b)(1)(e) and send a written plan on how this will be corrected by POC date. The administrator will also send the two incident reports.


Administrator stated she read section 80061(b)(1)(e) on fax sent on 12/05/2023. That did not meet the POC.


The original POC was due on 12/08/2023. As of today (12/15/2023) the facility has not submitted a POC for the deficiencies cited. Therefore, civil penalties will be issued for late POC.


Exit interview, report and appeal rights provided to facility.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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