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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606257
Report Date: 05/18/2021
Date Signed: 05/18/2021 12:21:30 PM

Document Has Been Signed on 05/18/2021 12:21 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA PASO ROBLES HOUSEFACILITY NUMBER:
197606257
ADMINISTRATOR:VEGA TAPIA, DANNYFACILITY TYPE:
735
ADDRESS:7306 PASO ROBLES AVETELEPHONE:
(818) 609-8227
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 3CENSUS: 3DATE:
05/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:08 AM
MET WITH:Danny Tapia Administrator TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Required Annual inspection. LPA met with Operations Administrator Danny Tapia and DSP Jose Milton Turcios and explained the reason for the visit.

Between 11:00am - 12:30pm, LPA conducted physical plant with Tapia. LPA did not observe any immediate health and safety concerns at this time.

Tapia informed LPA that not all staff have been fit tested for N95 respirators.

LPAs advised Tapia that they will provide resources to have all staff fit tested for N95 respirators.

Exit interview conducted with Tapia , report issued and sent via E-mail.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2021
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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