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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204399
Report Date: 10/04/2024
Date Signed: 10/04/2024 03:15:42 PM

Document Has Been Signed on 10/04/2024 03:15 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:VILLA REDONDO CARE HOMEFACILITY NUMBER:
198204399
ADMINISTRATOR/
DIRECTOR:		MARIA BRAVOFACILITY TYPE:
740
ADDRESS:237 REDONDO AVENUETELEPHONE:
(562) 434-9931
CITY:LONG BEACHSTATE: CAZIP CODE:
90803
CAPACITY: 80CENSUS: 64DATE:
10/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:27 PM
MET WITH:Kyra OlguinTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 10/04/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced visit at the above facility to address two separate physical altercations on 02/10/24 8:00 AM and 09/05/24 8:00 AM between Resident #1 (R1) and Resident #2 (R2). LPA met with Staff Kyra Olguin and explained the purpose of the visit.

Based on record review and interviews, the facility did not complete a reappraisal for R1 and R2 after either incident. The last reappraisal for R1 is dated 06/02/23 and 08/31/23 for R2. Interviews conducted indicated that R1 makes inappropriate remarks. Record review and interviews revealed that R2 has a history of aggression. A Technical Violation is being cited based on interviews and record review in accordance with the California Code of Regulations, Title 22, see LIC9102.

LPA observed two video surveillance recordings of R1 and R2 fighting on both dates listed above. Both incidents occurred in the hallway near the dining room prior to breakfast. The recordings did not capture staff in the frame to break the altercation up. Technical Assistance provided in accordance with the California Code of Regulations, Title 22, see LIC9102.

An exit interview was conducted and a copy of this report was provided to the Staff Kyra Olguin.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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