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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602885
Report Date: 06/27/2024
Date Signed: 06/27/2024 03:58:10 PM

Document Has Been Signed on 06/27/2024 03:58 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:BRADDOCK HOMEFACILITY NUMBER:
198602885
ADMINISTRATOR/
DIRECTOR:		DRUMMOND, MARIAFACILITY TYPE:
740
ADDRESS:12136 BRADDOCK DRIVETELEPHONE:
(310) 902-4893
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY: 4CENSUS: 4DATE:
06/27/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:31 AM
MET WITH:Briana Simpson, Facility ManagerTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 6/27/2024 at 3:36 pm Licensing Program Analyst (LPA), David España attempted visit to Successful People, LLC located at above address. Regional Office made contact with licensee/administrator to gain access and all attempts were unsuccessful. LPA was advised to initiate complaint visit at facility: Braddock Home, Facility# 198602885, Located at 12136 Braddock Drive.

During visit, LPA España met with Briana Simpson, Facility Manager to discuss purpose of the visit.

Due to time constraints and inaccessibility to the physical plant, complaint needs further investigation. A non-compliance conference will be scheduled with licensee for a future date.

No deficiencies cited during visit.

Exit interview conducted with Briana Simpson, Facility Manager.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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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