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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610084
Report Date: 10/05/2022
Date Signed: 10/05/2022 12:08:22 PM

Document Has Been Signed on 10/05/2022 12:08 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:EASTERSEALS SOUTHERN CALIFORNIA INCFACILITY NUMBER:
197610084
ADMINISTRATOR:FERNANDEZ, CYNTHIAFACILITY TYPE:
775
ADDRESS:44480 20TH STREET WTELEPHONE:
(818) 388-7428
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 100CENSUS: 19DATE:
10/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Danshelle DayTIME COMPLETED:
11:45 AM
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LPA Spaeth conducted an unannounced annual visit to the facility and was greeted by staff member. LPA observed the reception desk which contained a sign in sheet, thermometer, hand sanitizer and additional masks. LPA's temperature was recorded and LPA answered the required COVID questions. LPA was greeted by Danshelle Day and both began the tour at 10:55 am. COVID signs are posted at the front door and throughout the facility.

There are six bathrooms throughout the building. LPA observed each bathroom was clean and contained wash your hands sign, paper towels, hand soap, and trash can. There are eight open rooms and observed several staff members working one on one with clients. All staff throughout the building were wearing masks.

LPA observed the kitchen/dining room combination. LPA observed a client was eating lunch within the dining room area. The tables are set up for three to four clients at each table which allows for social distancing when clients are eating. The break room also contained several tables with chairs. LPA observed wash your hands sign, hand soap and paper towels within the kitchen area.

LPA was then escorted to a storage area which contained a 90 day supply of PPE including surgical masks, hand sanitizer, hand soap, gloves and other needed supplies.

There are no deficiencies to report at this time. Exit interview conducted, and LPA confirmed a copy of the signed report will be emailed to Administrator.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2022
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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