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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320366
Report Date: 05/11/2023
Date Signed: 05/11/2023 09:39:12 AM

Document Has Been Signed on 05/11/2023 09:39 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:FAMILY FIRST BOARD & CAREFACILITY NUMBER:
198320366
ADMINISTRATOR:FAMISAN, ROSEMARIEFACILITY TYPE:
740
ADDRESS:14532 HALLDALE AVETELEPHONE:
(310) 910-6142
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 6CENSUS: 6DATE:
05/11/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Rosemarie FamisanTIME COMPLETED:
09:45 AM
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On 05/11/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an announced visit to the listed facility above. LPA met with Licensee, Rosemarie Famisan, and discussed the purpose of today's visit. During time of visit six (6) residents were present.

During today's visit LPA Gibbs and Licensee Famisan walked the grounds. LPA inspected the garage, and observed that the garage is no longer being used as a living space. The space is being utilized according to facility sketch, LPA Gibbs observed a car and motorcycle parked in the garage, and a small area being used for storage.

LPAGibbs provided Licensee Famisan with regulations 87611, 87612, 87617, and 87618 per LPM Alvarez's request. LPM Alvarez informed LPA Gibbs, they will contact CAB regarding today's visit

An exit interview was conducted with Licensee/Administrator Rosemarie Famisan and a copy of this report was provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2023
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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