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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004436
Report Date: 06/20/2024
Date Signed: 06/20/2024 01:04:18 PM

Document Has Been Signed on 06/20/2024 01:04 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:STONYBROOK RESIDENTAL CARE IIFACILITY NUMBER:
306004436
ADMINISTRATOR/
DIRECTOR:		CLIFFORD T VALMEOFACILITY TYPE:
735
ADDRESS:2301 PEPPERWOOD AVENUETELEPHONE:
(562) 498-4413
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 4CENSUS: 4DATE:
06/20/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:02 AM
MET WITH:Cesar EguilosTIME VISIT/
INSPECTION COMPLETED:
12:37 PM
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On 06//20/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted a Case Management Health Check visit at this facility. LPA met with House Manager Cesar Eguilos. LPA explained the purpose of this visit is to gather information regarding a current complaint about control # 11-AS-20231106093830.

The visit consisted of an interview with Administrator Brandon Penalosa and House Manager Cesar Eguilos are both responsible for the care and supervision of the Harbor Regional Center consumers residing at this site to verify that staff #1 (S1) associated with complaint #11-AS-20231106093830 is excluded and dissociated is no longer working at any Community Care Licensing facilities effective 11/01/23. Penalosa and Equilos confirmed through interview and provided a copy of a current Personnel Report LIC 500. LPA Dabuet inspected the facility and found no evidence that (S1) was performing duties at this licensed facility.

An exit interview was conducted with Cesar Eguilos, and a hard copy was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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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