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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204998
Report Date: 05/01/2023
Date Signed: 05/01/2023 04:44:15 PM

Document Has Been Signed on 05/01/2023 04:44 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ANZA HOME CAREFACILITY NUMBER:
198204998
ADMINISTRATOR:RODRIGO RAMOSFACILITY TYPE:
740
ADDRESS:19917 ANZA AVENUETELEPHONE:
(310) 370-9613
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY: 6CENSUS: 4DATE:
05/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Patricia Changco - House ManagerTIME COMPLETED:
04:59 PM
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On 05/01/2023 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual inspection visit at the above facility. LPA Leon was met by Patricia Changco, House Manager.
During today's inspection a physical plant tour was conducted with Mrs. Changco. LPA conducted facility, staff and resident records review.

During today's visit, there were no deficiencies cited. Due to time constraints, an unannounced subsequent annual inspection will be conducted.

An exit interview was conducted and a copy of this report was provided to Mrs. Changco, House manager.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2023
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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