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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881292
Report Date: 07/29/2024
Date Signed: 07/29/2024 04:39:07 PM

Document Has Been Signed on 07/29/2024 04:39 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:GUARDIAN HOME CARE LLCFACILITY NUMBER:
331881292
ADMINISTRATOR/
DIRECTOR:		ROBINSON, BLAIR ALAYNEFACILITY TYPE:
735
ADDRESS:25365 THEDA STTELEPHONE:
(310) 908-7702
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY: 4CENSUS: 0DATE:
07/29/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:55 PM
MET WITH:Raye Robinson, Corporate Board MemberTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Yolanda Delgado made an announced visit to conduct the Annual inspection, there are currently zero (0) clients in care and no staff on duty. Raye Robinson, Board member advised they are in the process to be vendorized by IRC. LPA toured the facility inside, all bedrooms are set-up. LPA completed the Physical Plant, Infection Control and Emergency Disaster modules. Administrator’s license expiration date is 08/29/2024.

LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed four (4) dual fire and carbon monoxide detectors. There was three (3) fire extinguisher on site.

Based on the information received during this visit today in the areas reviewed, there are zero (0) deficiencies observed per Title 22, Division 6 of The California Code of Regulations.

This LIC 809 was reviewed with and a copy will be provided to the Raye Robinson.


SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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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