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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366427230
Report Date: 03/03/2022
Date Signed: 03/03/2022 04:49:46 PM


Document Has Been Signed on 03/03/2022 04:49 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:BLOOMINGTON CARE CENTER INCFACILITY NUMBER:
366427230
ADMINISTRATOR:LAYGO, ANITAFACILITY TYPE:
735
ADDRESS:17552 MAYWOOD STTELEPHONE:
(909) 421-2006
CITY:BLOOMINGTONSTATE: CAZIP CODE:
92316
CAPACITY:6CENSUS: DATE:
03/03/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Arecelia LaygoTIME COMPLETED:
03:30 PM
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A virtual office meeting was held on this date for the purpose of discussing the continued operation of Covell Care Center owned by Arcelia Laygo and Armando Laygo, following the passing of Licensee, Armando Laygo. The following individuals were in attendance: Leslie Mendieveles , Regional Manager, Reyna Lacey, Regional Manager, Efren Malagon, Licensing Program Manager, Karen Clemons, Licensing Program Manager, Deborah Mullen, Licensing Program Manager, Stephanie Torres, Licensing Program Analyst, and Javier Prieto, Licensing Program Analyst, Arcelia Laygo, Licensee, Anita Laygo, Managing Member, Adrian Laygo, Managing Member, Allison Laygo, Managing Member, Cielita Ravelo, Licensee Consultant,. The following facilities were discussed: Anita Care Center (361880765), Ashley Care Center (361800133), Andrew Care Center (366424647), A.L Care Center (366423743), Bloomington Care Center (366427230), Faustina Care Center (366424320), Hacienda Care (366426867), Misty Care Center (366413192), Vista Care Center (366425828).

Ms. Lago confirmed there would be no changes regarding the ownership of the facility or in the continued operation of the facility. Ms. Lago agreed to provide the following updated documents to the Department by Monday March 7, 2022: Application for A Community Care Facility (LIC 200), Administrative Organization (LIC 309), Personnel Report (LIC500) and Designation of Facility Responsibility (LIC 308) .

An exit interview was attempted by telephone whereby this report would have been reviewed with Ms. Laygo, however, she was unavailable. The report was emailed to Ms. Laygo for her review and signature.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: 9512480349(323) 981-3968
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
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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