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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601976
Report Date: 01/09/2024
Date Signed: 01/09/2024 11:37:39 AM

Document Has Been Signed on 01/09/2024 11:37 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DEL MAR PARKFACILITY NUMBER:
198601976
ADMINISTRATOR:DENISE SUTTONFACILITY TYPE:
740
ADDRESS:990 EAST DEL MAR BOULEVARDTELEPHONE:
(626) 577-0215
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY: 60CENSUS: 54DATE:
01/09/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:41 AM
MET WITH:Denise Sutton - Administrator TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Denise Sutton and explained the reason for the visit.

During this visit LPA Flores concluded the inspection and reviewed the following domains from the CARE inspection tool: Infection Control, Staffing, Incidental Medical and Dental, and Disaster Plan.

LPA reviewed medication for 5 residents, infection control plan last reviewed on 6/4/23, First Aid/CPR certificates for 5 staff, and Disaster Plan last reviewed 12/17/23.
Last fire drill was conducted on 11/28/23. Evacuation chair was order by the administrator invoice was observed.

LPA interview 2 staff and 2 residents.

No deficiencies were noted during this visit.

Exit interview was conducted with Denise Sutton and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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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