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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670621
Report Date: 07/29/2024
Date Signed: 08/15/2024 10:36:14 AM

Document Has Been Signed on 08/15/2024 10:36 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:ADULT DEVELOPMENT CENTER-GARDENAFACILITY NUMBER:
191670621
ADMINISTRATOR/
DIRECTOR:
MICHAEL MURPHYFACILITY TYPE:
775
ADDRESS:13515 SO. VERMONT AVE.TELEPHONE:
(310) 532-6271
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 77CENSUS: 37DATE:
07/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Jenna Pierce, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On 7/29/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA met with Program Manager, Jenna Pierce 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. There are 37 clients present today.

On 7/29/24, LPA Shirley and Jenna toured the Facility. 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 consists 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 Shirley reviewed 5 client files and 5 staff files and all had required documents.

LPA Shirley and Jenna 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.

Four (7) fire extinguishers were observed to be fully charged. The last fire drill was conducted on 7/23/24 and earthquake drill on 7/1/24.

No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a hard copy of this report was provided to Jenna Pierce.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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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