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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197806686
Report Date: 10/27/2022
Date Signed: 10/27/2022 01:52:16 PM

Document Has Been Signed on 10/27/2022 01:52 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
LA & TRI-COASTAL CR, 1000 CORPORATE CNTR DR. #200A
MONTEREY PARK, CA 91754
FACILITY NAME:CENTER FOR DISCOVERY-WHITTIERFACILITY NUMBER:
197806686
ADMINISTRATOR:SAM EDMANFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 25CENSUS: 19DATE:
10/27/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Samuel Edman- AdministratorTIME COMPLETED:
01:30 PM
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An unannounced annual inspection was conducted by Licensing Program Analysts (LPAs) Carrie Palmer and Johanna Lofton on October 27, 2022 at 10:30am. During this visit, LPAs met with Facility Manager Samuel Edman and Kelly Gonderman Assistant Program Director. LPAs reviewed staff training plans, training logs, records of restraints/logs in their electronic tracking system; as well as Quarterly Board Meeting Minutes. Current census is 21.

During the inspection, LPAs completed the following domains: Emergency Intervention Plan and Operational Requirements. Both domains were in compliance.

Exit interview was conducted and a copy of this report was emailed to administrators.

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SUPERVISORS NAME: Tira Logan
LICENSING EVALUATOR NAME: Carrie Palmer
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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