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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608164
Report Date: 11/21/2024
Date Signed: 11/21/2024 02:29:15 PM

Document Has Been Signed on 11/21/2024 02:29 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ROLYN HOMEFACILITY NUMBER:
197608164
ADMINISTRATOR/
DIRECTOR:
RONALD MANALADFACILITY TYPE:
740
ADDRESS:10622 LEEDS STREETTELEPHONE:
(562) 868-1560
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 6CENSUS: 3DATE:
11/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Eadgitha "Jody" Manalad/S-1TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Case Management visit. LPA met with Eadgitha "Jody" Manalad/S-1 and discussed the purpose of today's visit.

The purpose of today's visit is to follow up an incident involving C-1 and C-2. It was alleged that C-1 attempted to "smother" C-2 and that C-1 stole C-2's belongings. During this visit, LPA obtained a copy of the staff and client rosters, reviewed and obtained documentation from Client #1 (C-1) and Client #2 (C-2) files, interviewed C-1 and C-2, interviewed Staff #1 (S-1) through Staff #3 (S-3) and interviewed the Quality Assurance Representative from Harbor Regional Center. LPA was unable to interview Client #3 (C-3) due to a language barrier.

Staff interviews and reviewed documentation revealed that C-1 has a history of fabricating stories. Interviewed staff indicated that they have not received any complaints pertaining to this allegation. C-2 denies this incident.

No deficiencies cited as there was not enough evidence to support the allegation. Exit interview conducted and a copy of this report was provided to Eadgitha "Jody" Manalad/S-1.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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