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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570094
Report Date: 07/19/2024
Date Signed: 07/19/2024 02:50:47 PM

Document Has Been Signed on 07/19/2024 02:50 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DAY TRAINING ACTIVITY CENTERFACILITY NUMBER:
191570094
ADMINISTRATOR/
DIRECTOR:		SOSA, EMILIOFACILITY TYPE:
775
ADDRESS:9555 WASHBURN RD.TELEPHONE:
(562) 803-3391
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 65CENSUS: 7DATE:
07/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Amy G.Scott -CFOTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Tyler Reyes conducted unannounced annual inspection. LPA met with Chief Financial Officer (CFO) Amy G.Scott and explained the reason for the visit. The facility is licensed to serve 58 Ambulatory and 7 Non-Ambulatory developmentally disabled adults ages 18 and above.

The facility is located in an industrial area in Downey Ca. There are 4 activity rooms, 1 computer room, 2 storage rooms, 5 offices, 1 women's restroom with 3 stalls, 1 men's restroom with 2 urinals and 2 stalls, 2 staff restrooms, staff lounge area and reception area.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility staff are using appropriate hand hygiene while assisting clients’. Staff are cleaning and disinfecting throughout the day.
Physical Plant and Environmental Safety: There are carbon monoxide detectors and fire alarms that are in compliance and operable. Facility is clean, safe, sanitary and in good repair. Disinfectants, cleaning solutions and other items that could possibly pose danger to clients are centrally stored in locked cabinets and locked storage rooms.
Operational Requirements: Facility maintains an approved fire clearance. Staff are knowledgeable on reporting requirements of abuse.

Staffing: There seems to be sufficient staffing in facility during hours of operation.

(Continued on 809-C)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: DAY TRAINING ACTIVITY CENTER
FACILITY NUMBER: 191570094
VISIT DATE: 07/19/2024
NARRATIVE
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Personnel Records-Training: LPA Reyes observed upon record review of the Facility Personnel Report Summary dated 7/19/24 staff #1 (S1) is not cleared. CFO Scott stated S1 has been working as an employee from 2/1/1994 - 7/19/24. Staff has ongoing training and health screening on file. Personnel files are kept locked in a secure location within the facility.
Client Records-Incident Reports: Client files are kept in a secured location and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan.
Client Rights-Information: The facility has Personal Rights Poster posted. There are no clients in care that are in need of any postural supports.
Food Service: Clients bring their own food in lunch bags and are stored away from any toxic substances.
Health-Related Services: Staff that have direct contact with clients have their proper CPR training on file.
Incidental Medical Services: Staff have proper training to meet the needs of clients in care.
Disaster Preparedness: There is a emergency disaster and mass casualty plan readily available at the facility that includes transportation arrangements, evacuation procedures, local emergency contact information and emergency shut off valve locations.
Emergency Intervention: Clients at this facility do not require the use de-escalation techniques.


Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached 809D. Exit interview held. A copy of the report and appeal rights were provided to caregivers.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 07/19/2024 02:50 PM - It Cannot Be Edited


Created By: Tyler Reyes On 07/19/2024 at 02:04 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: 07/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82019(e)
Criminal Record Clearance
(e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review of Staff #1 (S1), the licensee did not comply with the section cited above in which poses an immediate health, safety to persons in care. LPA Reyes observed upon record review of the Facility Personnel Report Summary dated 7/19/24 S1 is not cleared.
POC Due Date: 07/19/2024
Plan of Correction
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CFO Amy G. Scott will not allow S1 to work without proof of fingerprint clearance and will certify that all staff working at this facility will have fingerprint clearance and will be associated to the facility prio to working. Civil penalties attached.
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:Fernando Fierros
LICENSING EVALUATOR NAME:Tyler Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/19/2024 02:50 PM - It Cannot Be Edited


Created By: Tyler Reyes On 07/19/2024 at 02:04 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: 07/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82023(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above which poses potential health, safety risk to persons in care. CFO Amy G. Scott provided LPA with copies of the there most recent Fire/Earthquake Drills for August 8,2023. LPA confirmed with CFO Scott this was the most recent Disaster Drill on file.
POC Due Date: 07/26/2024
Plan of Correction
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CFO Amy G. Scott will provide proof of a Distaser Drill via email to LPA Reyes by POC Due Date.
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:Fernando Fierros
LICENSING EVALUATOR NAME:Tyler Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024


LIC809 (FAS) - (06/04)
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