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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670621
Report Date: 08/18/2021
Date Signed: 08/18/2021 11:56:44 AM

Document Has Been Signed on 08/18/2021 11:56 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 DR #100
MONTERY PARK, CA 91754
FACILITY NAME:ADULT DEVELOPMENT CENTER-GARDENAFACILITY NUMBER:
191670621
ADMINISTRATOR:MICHAEL MURPHYFACILITY TYPE:
775
ADDRESS:13515 SO. VERMONT AVE.TELEPHONE:
(310) 532-6271
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 77CENSUS: 0DATE:
08/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Michael Murphy-Program ManagerTIME COMPLETED:
12:00 PM
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On 8/18/2021, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA met with Program Director Michael Murphy and explained the purpose of today’s visit. The facility is licensed for seventy-seven (77) ambulatory clients of which thirty-eight (38) may be non-ambulatory.

Facility grounds consist of the following: Front and back gated parking lots. Front building consist of reception area/lobby, kitchen, 4 staff/visitor’s restrooms, office, 2 classroom/activity rooms and 2 client restrooms. Back building consist of a wellness room with a client restroom, 3 classrooms/activity rooms which contains a restroom and 1 staff restroom. There is a shaded area between the buildings. Common areas such as bathrooms and classrooms were observed to be neat, clean, and properly furnished.

LPA and Program Director Murphy toured the physical plant. There were no bodies of water or obstructions on the premises. Bathrooms were found to be within Title 22 regulations and were clean and operational.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. Fire extinguishers are fully charged.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a hard copy of this report was provided to Program Director Micheal Murphy by email.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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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