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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601704
Report Date: 08/13/2021
Date Signed: 08/13/2021 04:41:51 PM

Document Has Been Signed on 08/13/2021 04:41 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME:HARMONY HOME CAREFACILITY NUMBER:
198601704
ADMINISTRATOR:DIONSIO, ANTONIAFACILITY TYPE:
740
ADDRESS:1318 215TH STREETTELEPHONE:
(310) 549-0218
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 6CENSUS: 6DATE:
08/13/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:ELMER CALOS TIME COMPLETED:
02:31 PM
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On 08/13/21, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Proof of Correction visit at the facility and met with House Manager Elmer Carlos and explained the purpose of today’s visit is to conduct a plant inspection and health and safety check.

The facility was cited with a Type B Section 87303 (a) Maintenance and Operation on 08/03/21. The bathroom wall, lighting fixtures, refrigerator, and dishwasher were unsanitary and the kitchen area had pests.

LPA conducted a plant inspection by inspecting the interior and exterior of the facility. LPA observed that the Licensee corrected the violations. The facility is now in compliance with the California Code of Regulations Title 22 Division 6.

An exit interview was conducted and a Facility Evaluation Report was provided to Elmer Carlos House Manager.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2021
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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