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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320306
Report Date: 08/23/2024
Date Signed: 08/23/2024 03:34:00 PM

Document Has Been Signed on 08/23/2024 03:34 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:MARCOSA'S VILLAFACILITY NUMBER:
198320306
ADMINISTRATOR/
DIRECTOR:		FIGUEROA, JUN FAUSTO D.FACILITY TYPE:
740
ADDRESS:1024 E. FREELAND STREETTELEPHONE:
(562) 428-0033
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: 6CENSUS: 6DATE:
08/23/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:34 PM
MET WITH:Rosita Matute, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On August 23, 2024 Licensing Program Analyst (LPA) conducted unannounced Case Management-Annual Continuation for the purpose of completing the Annual required inspection started on August 22, 2024. LPA met with Rosita Matute, Licensee and explained purpose of today's visit.

During this visit, LPA reviewed six (6) staff files. Six (6) out of six (6) files met licensing requirements. All staff were

During this visit LPA reviewed six (6) Residents files. Six (6) out of six (6) files met licensing requirements.

No deficiencies are being cited.

An exit interview was conducted. A copy of this report was provided to Rosita Matute, Licensee.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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