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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670621
Report Date: 09/20/2023
Date Signed: 09/20/2023 03:16:49 PM

Document Has Been Signed on 09/20/2023 03:16 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY 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: 55DATE:
09/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director Michael MurphyTIME COMPLETED:
12:15 PM
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On 09/20/2023, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit, LPA met with Program Director Michael Murphy and explained the purpose of today’s visit. The facility is licensed for seventy-seven(77) clients ages 18-59 of which thirty-nine (39) may be ambulatory and thirty-eight (38) non-ambulatory. Clients are linked to the Westside regional center.

Facility grounds consist of the following: 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 clean, and properly furnished. Clients bring their own meals or funds to purchase meals outside of the facility.

LPA and Program Director Murphy toured the physical plant. There were no bodies of water or obstructions on the premises. Facility is 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, first aid is complete.

As part of today's visit LPA Reviewed 5 client records and 2 staff records. Smoke alarms and carbon monoxide were observed to be operational. Last fire drill was conducted on 08/1/23 and earthquake drill was on 08/24/23. Liability insurance is active, Director informed of overdue fees and provided with PIN.LPA observed walkways throughout the day program and all exits were clear of hazards and debris.
During today’s visit Tech V was observed and documented on 9102. Exit interview conducted with Program

Director Michael Murphy and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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