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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320317
Report Date: 02/24/2023
Date Signed: 02/24/2023 12:47:35 PM

Document Has Been Signed on 02/24/2023 12:47 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:CASA ESPERANZAFACILITY NUMBER:
198320317
ADMINISTRATOR:AGATEP, EVANGELINEFACILITY TYPE:
740
ADDRESS:1080 VIA LA PAZTELEPHONE:
(310) 787-7300
CITY:SAN PEDROSTATE: CAZIP CODE:
90732
CAPACITY: 6CENSUS: 0DATE:
02/24/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:09 PM
MET WITH:Melanie TalladaTIME COMPLETED:
12:47 PM
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On 2/24/2023, LPA Alfonso Iniquez and LPM Eva Alvarez conducted a Pre-license correction visit at this facility. LPA and LPM met with Administrator Assistant visit Melanie Tallada who assisted with this visit. During this visit, LPA and LPM observed a water leaking from the ceiling in the dining area. The water appeared to be dripping from the ceiling fan. LPA and LPM were made aware of a smoke detector in the staff room needing a charged battery as it was beeping. Corrections are needed at this time for the water leaking from the ceiling and smoke detector requiring a battery.

Needed corrections:

Water leaking from ceiling in dining room. POC: Repair roof to ensure no leaking occurs
Smoke alarm battery low POC: Replace battery in smoke detector.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CASA ESPERANZA
FACILITY NUMBER: 198320317
VISIT DATE: 02/24/2023
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Previously required corrections below have been corrected as of 2/24/2023.

Bathroom #1- mold present in caulk/sealer around bathtub. POC: Licensee shall provide a safe and healthful environment. Licensee will ensure mold is removed from bathtub caulk/sealant.

Bathroom #1- medicine cabinet has rust present on base level. POC: Licensee will ensure rust is removed from medicine cabinet

Bathroom #2 – (2) vanity cabinet doors do not close properly. POC: licensee will repair or replace cabinet doors.

Bathroom #2 – caulking/sealant around shower floor has mold present. POC: licensee will ensure mold is removed.

Bathroom #2 – caulk/sealant around bathtub has mold and rust present inside bathtub.

POC: licensee will shall ensure mold and rust is removed from bathtub.

Nightlights are not present where required and emergency flashlights are not working properly. POC: Licensee will ensure required lighting is present in facility.

Exit Interview conducted and copy of report given to Melanie Tallada.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023
LIC809 (FAS) - (06/04)
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