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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600097
Report Date: 03/16/2022
Date Signed: 03/16/2022 01:35:44 PM

Document Has Been Signed on 03/16/2022 01:35 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ABILITYFIRST LONG BEACH CENTER ADULT DAY PROGRAMFACILITY NUMBER:
191600097
ADMINISTRATOR:SCHLOSSER, BARBARAFACILITY TYPE:
775
ADDRESS:3770 E WILLOW STTELEPHONE:
(562) 426-6161
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 40CENSUS: DATE:
03/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Jordan QuenunTIME COMPLETED:
01:35 PM
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On 03/16/22 Licensing Program Analyst (LPA) Jade Jordan conducted an un-announced annual inspection with an emphasis on infection control. LPA was met by Adult Day Program ( ADP ) Supervisor Jordan Quenun, and the purpose of the visit was explained.

Upon entry Lpa observed Covid-19 posting on the automatic doors. LPA was screened for Covid-19 questions using a QR code, at the entry of the door, and temperature was manually taken by staff as part of the screening. LPA was then led to the bathroom, were LPA was able to wash hands and practice good hand hygiene.

The Facility Building is located on a Main Street, with a front and side entrance.
The interior physical structure consisted of Two large multi use activities rooms, of which both rooms can be used for Adult Day Program Consumers, but hold a license, for an After School childcare Program. ADP clients are predominately community based. There is one commercial sized teaching kitchen, Green belt area for gardening, Outdoor activity area, Community based pool, enclosed, locked and secure, Laundry skills room, exercise room, and an administrative wing. A total of 6 bathrooms between the two activity areas, one of which is the designated isolation/sick room. The pool, and the administrative wing also include their own separate bathrooms. Hard wire smoke detectors, and separate smoke alarms were observed throughout the facility, fully operational. They are directly connected to the fire department, and was last serviced/ inspected on 08/20/21.

There are 5 service vehicles, all in good working condition, and currently up to date with service and tags.
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2022
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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ABILITYFIRST LONG BEACH CENTER ADULT DAY PROGRAM
FACILITY NUMBER: 191600097
VISIT DATE: 03/16/2022
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Bathrooms were clean and free of mold/mildew. Walkways were clear and free of obstruction and debris.

LPA reviewed 2 consumer records, and 2 staff records. All files had the required documents.

The facility is following their mitigation plan. LPA observed over the minimum supply of PPE's
which included: Face Shields, Surgical Masks, N95's, Gloves, Disinfectant, Paper towels, Soap,
gowns, and Hand Sanitizer. The facility screens and logs all visitors, staff, consumers for Covid-19 symptoms prior to entry into the facility. The facility has an emergency plan in place, and has designated staff that will
work with a consumer should they fall ill with covid-19 while under their care.

N95 fit testing has been provided to staff, and the facility continues to offer Covid-19 testing to all staff on a weekly basis.

An exit interview was conducted and a copy of this report was provided. No deficiencies were noted during this visit, and no citations were issued.
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
LIC809 (FAS) - (06/04)
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