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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004436
Report Date: 11/16/2023
Date Signed: 11/16/2023 03:41:25 PM

Document Has Been Signed on 11/16/2023 03:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:STONYBROOK RESIDENTAL CARE IIFACILITY NUMBER:
306004436
ADMINISTRATOR:CLIFFORD T VALMEOFACILITY TYPE:
735
ADDRESS:2301 PEPPERWOOD AVENUETELEPHONE:
(562) 498-4413
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 4CENSUS: 3DATE:
11/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:ADMINISTRATOR BRANDON PENALOSATIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced case management visit to the facility Stonybrook Residential Care 2. The purpose of today’s visit was to serve the Order to Licensee of Immediate Exclusion from Facility for staff (S1). An investigation by the California Department of Social Services was conducted and it was determined that staff (S1) violated California Code of Regulations Title 22 for personal rights.

On today's visit, LPA Calderon met with Administrator Brandon Penalosa and explained the reason for the visit. Administrator Brandon Penalosa was provided with copies of the Order to Licensee of Immediate Exclusion and Order to Individual for Immediate Exclusion letters and Government Code 11522.

NOTE: El Segundo Regional Office Immediate Exclusion letters for facilities: Stonybrook Residential Care 2 306004436 2301 Pepperwood Ave Long Beach 90808 were also issued to facility staff.

The exit interview was held with Administrator Brandon Penalosa. A copy of the report was issued.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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