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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320317
Report Date: 03/29/2023
Date Signed: 03/29/2023 09:41:24 AM

Document Has Been Signed on 03/29/2023 09:41 AM - 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:
03/29/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Melanie Tallada-Assistant AdministratorTIME COMPLETED:
09:41 AM
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On 3/29/2023 at 9:00 AM LPA Alfonso Iniquez conducted an announced Pre-license correction visit at this facility. LPA met with Administrator Assistant Melanie Tallada who assisted with this visit. During this visit, LPA together with Assistant Administrator toured the facility. LPA observed no leak on the kitchen/dinning area and the smoke alarm battery has been replaced.
At 9:15 AM LPA Iniguez and Assistant Administrator toured the inside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathroom was found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients.

Component III was conducted during visit

Provided information about how to operate the facility within substantial compliance.

During the pre-licensing inspection there were no deficiencies observed.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023
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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