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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320498
Report Date: 10/04/2024
Date Signed: 10/04/2024 10:48:43 AM

Document Has Been Signed on 10/04/2024 10:48 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:GENERATIONS OF LOS ANGELES ASSISTED LVNG. FACILITYFACILITY NUMBER:
198320498
ADMINISTRATOR/
DIRECTOR:		CAMARIN JOHNSONFACILITY TYPE:
740
ADDRESS:3540 MARTIN LUTHER KING, JR.TELEPHONE:
(310) 638-4113
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 178CENSUS: 64DATE:
10/04/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Admnistrator - CAMARIN JOHNSONTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On 10/04/2024 at around 8:00 AM, Licensing Program Analyst (LPA) Leandro conducted an unannounced collateral visit regarding the former Licensee (Vista Veranda Assisted Living). LPA was met by Administrator Camarin Johnson and explained the purpose of the visit. LPA interviewed former residents and staff from Vista Veranda Assisted Living; LPA interviewed 7 residents and 6 staff.

An exit interview was conducted and a copy of this report was provided to the Administrator.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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