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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610084
Report Date: 12/05/2023
Date Signed: 12/05/2023 02:01:54 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/05/2023 02:01 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: 65DATE:
12/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Carlos Guillen TIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at approximately 12:30 pm and was greeted by staff. LPA observed the reception area which contained a seating, sign in sheet, thermometer, hand sanitizer and additional masks, and containers for clean and dirty pens used to sign in. The administrator was present at the facility.

LPA conducted a tour of the physical plant at approximately 12:40 pm to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

The facility has nine (9) activity spaces, media room, main activity large room, four (4) storage rooms, personal care room, and janitorial room. The storage rooms PPEs, supplies including masks, hand sanitizer, hand soap, and paper towels.
There are (8) eight bathrooms in the facility. Bathrooms has the following items available: hand soap, paper towels, and trash cans. Four (4) randomly selected bathrooms hot water measured to ensure it is within the required range for client’s comfort and safety. The water temperature range was between 108.6, 109.2, 117.7, and 118.6 -degrees Fahrenheit.

LPA observed the kitchen and café area. LPA observed clients was eating lunch in the café area. Facility common spaces and work areas, and furniture observed to be clean and in good repair.

Cleaning supplies/toxins observed to be locked in janitorial closet and inaccessible to clients.

There are two (2) first aid kits in the facility.There are seven (7) fire extinguishers throughout the facility observed to be charged.
There are no deficiencies to report at this time.

Exit Interview Conducted /Copy of the Report Issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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