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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603538
Report Date: 11/28/2023
Date Signed: 11/28/2023 09:51:14 AM

Document Has Been Signed on 11/28/2023 09:51 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:ALL IN CAREHOMEFACILITY NUMBER:
198603538
ADMINISTRATOR:YAMASHIRO, SHELLYFACILITY TYPE:
740
ADDRESS:1158 BEAVER WAYTELEPHONE:
(626) 698-9615
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY: 6CENSUS: 5DATE:
11/28/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Edwin Uy - CaregiverTIME COMPLETED:
10:05 AM
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Licensing Program Analyst (LPA) Mora conducted an unannounced plan of correction (POC) visit to follow up on deficiencies noted on 10/26/23. LPA met with Edwin Uy (Caregiver) and explained the reason for the visit.

On 10/26/23, LPA Mora conducted a complaint investigation visit and cited the following deficiencies:
87305(a) Alterations to Existing Building or New Facilities and 87303(a) Maintenance and Operation. On 10/26/23, LPA observed an unpermitted room in the facility's garage and was deemed a fire hazard by a City of La Verne Building Inspector and Code Compliance Officer. During today's visit, LPA observed that the unpermitted room has been demolished.

Exit interview was conducted with Edwin Uy (Caregiver) and a copy of this report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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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