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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198200792
Report Date: 02/25/2022
Date Signed: 02/25/2022 06:11:03 PM

Document Has Been Signed on 02/25/2022 06:11 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, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME:EPI CENTERFACILITY NUMBER:
198200792
ADMINISTRATOR:DYE, MORGANFACILITY TYPE:
775
ADDRESS:3926 W. 139TH STREETTELEPHONE:
(310) 978-1254
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 25CENSUS: DATE:
02/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Morgan Dye/ Shir DyerTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Jey Cardenas conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Cardenas met with Director, Morgan Dye and Program Administrator Shir Dyer. The purpose of today’s visit was discussed. The facility prefers to serve 25 developmentally disabled clients 18, years and above. Facility approved for 15 non-ambulatory and 10 ambulatory clients. LPA was granted access and allowed to enter the facility to conduct inspections. At this time program is operating virtualyl and zero (0) clients were present.

During the tour, LPA observed the facility’s infection control practices. LPA verified that the facility has an approved mitigation plan report. LPA was properly screened for Covid-19 symptoms, temperature was checked. PPE supplies are readily available to staff. observed all staff wear a face covering.

LPA and Director, both toured the grounds of the facility. Facility is located in a single story building, located in a commercial business area. LPA observed that the facility included: a large multipurpose room, 2 restrooms, a changing room, relaxation room, music room, art room, storage room, 2 staff offices, and one (1) Program director office, kitchen, and an indoor/ outdoor activity area. Documents are posted as mandated by Title 22 Regulations. Bathrooms are clean and operational; sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly; grab bars were secure, Comfortable temperature was maintained in the facility.

Smoke and Carbon Monoxide detectors are in compliance. All clients bring their own lunch. Hazardous items are inaccessible to clients, and kept in a storage cabinet. First aid kit is fully stocked with manual. Medications are centrally stored in a locked cabinet in the Program Director office. LPA observed three (3) fully charged fire extinguishers which were inspected June 8, 2021.



LPA toured the kitchen area and observed, kitchen is being remodeled, refrigerator on site with washer/
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: EPI CENTER
FACILITY NUMBER: 198200792
VISIT DATE: 02/25/2022
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dryer. No bodies of water were observed. Walkways were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions.

No deficiencies were cited during this visit. Advisory Note with technical assistance issued: Ensure staff are fit tested for respirator masks.

*LPA to email fit testing resources, additional posters/ signs.


According to the California Code of Regulations (Title 22, Division 6, Chapter 1), LPA did not observe deficiencies; therefore, no citations are issued. An exit interview was conducted and a Facility Evaluation Report was provided to Morgan Dye Shir Dyer.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
LIC809 (FAS) - (06/04)
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