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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570094
Report Date: 11/30/2021
Date Signed: 12/01/2021 09:20:40 AM

Document Has Been Signed on 12/01/2021 09:20 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DAY TRAINING ACTIVITY CENTERFACILITY NUMBER:
191570094
ADMINISTRATOR:LINDLEY, DONNAFACILITY TYPE:
775
ADDRESS:9555 WASHBURN RD.TELEPHONE:
(562) 803-3391
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 65CENSUS: 8DATE:
11/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Donna LindleyTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nicole Spencer conducted an unannounced annual inspection focusing on the infection control domain. LPA Spencer was met by the administrator Donna Lindley, and explained the purpose of today's visit. The day program consists of a lobby area, participant storage lockers, four (4) activity rooms, two (2) client restrooms, two (2) staff restrooms, storage rooms, and staff offices.

The following was observed/inspected:

  • Passageways and walkways were free from obstruction.
  • The facility had a universal entrance screening area; sign-in log, screening, and temperature logs were maintained.
  • There was COVID-19 signage placed in the front entry and restrooms, but not in activity rooms/hallways.
  • Smoke detectors/carbon monoxide detector were in compliance and operational. Facility has fire pull alarms.
  • Facility maintained a 30-day supply of PPE except for face shields.
  • Hot water temperature was measured and was not within the required 105-120 degrees F. Hot water temperature in the restrooms measured between 98-103 degrees F.
  • A fire extinguisher was observed to be fully charged and last serviced in December 2020.
  • LPA observed sharp objects (safety pins, scissors) in cabinets located in the activity rooms, which could present a hazard to day program participants. The administrator immediately removed them and placed them in inaccessible area.
  • Client files were inspected and emergency contact information and health screenings were updated.
  • Staff files were inspected and contained required criminal record background checks, health screenings, TB test, and First-Aid/CPR.
  • This day program does not administer medications or serve meals.
Pursuant to Title 22, deficiencies were cited on the attached 809D page. An exit interview was conducted, a copy of this report, and appeal rights were provided via email.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: LaJean Nicole Spencer
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2021
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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Document Has Been Signed on 12/01/2021 09:20 AM - It Cannot Be Edited


Created By: LaJean Nicole Spencer On 11/30/2021 at 05:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DAY TRAINING ACTIVITY CENTER
FACILITY NUMBER: 191570094

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087.3(a)
Indoor Activity Space
(a) The licensee shall ensure safe and healthy indoor activity space for clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in due to accessibility of sharps such as safety pins and scissors, posing an immediate safety risk to persons in care.
POC Due Date: 11/30/2021
Plan of Correction
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The administrator immediately removed the sharps and placed in an inaccessible area. Corrected during visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christine Yee
LICENSING EVALUATOR NAME:LaJean Nicole Spencer
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2021


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 12/01/2021 09:20 AM - It Cannot Be Edited


Created By: LaJean Nicole Spencer On 11/30/2021 at 05:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DAY TRAINING ACTIVITY CENTER
FACILITY NUMBER: 191570094

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to restroom hot water temperature below the required range which poses a potential health risk to persons in care.
POC Due Date: 12/03/2021
Plan of Correction
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The administrator stated that the water temperature meter will be adjusted to ensure that the water temperture falls within the 105-120 range. The administrator will send pictures of water temperature gage to CCL by 12/3/21.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christine Yee
LICENSING EVALUATOR NAME:LaJean Nicole Spencer
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2021


LIC809 (FAS) - (06/04)
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