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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005856
Report Date: 11/05/2024
Date Signed: 11/05/2024 08:15:36 AM

Document Has Been Signed on 11/05/2024 08:15 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HAVEN FOR MOM & DAD 1FACILITY NUMBER:
306005856
ADMINISTRATOR/
DIRECTOR:		CALMA, RHODAFACILITY TYPE:
740
ADDRESS:1221 SIERRA VISTA DRTELEPHONE:
(562) 228-4439
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 6CENSUS: 5DATE:
11/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:30 AM
MET WITH:Jowel CalmaTIME VISIT/
INSPECTION COMPLETED:
08:30 AM
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This unannounced POC inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of verifying correction of deficiencies issued during the Required – 1 Year Inspection conducted on October 31, 2024. LPA met with Administrator (AD) Rhoda Calma and discussed the purpose of the inspection.

During the inspection, LPA and AD toured the facility and observed the following:

Type A Violation cited under California Code of Regulations (CCR) Title 22, Section 87307(a)(2)(B) pertaining to a resident living in a room marked as office on the facility sketch has been CLEARED. During the inspection, LPA and AD inspected the office, confirmed that no residents are living in that room, and confirmed that the resident that had been living in that room has been relocated to another room.

There were no deficiencies observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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