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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198200792
Report Date: 03/01/2024
Date Signed: 03/01/2024 03:04:32 PM

Document Has Been Signed on 03/01/2024 03:04 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
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: 24DATE:
03/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Shir Dyer, Director of Programming and Clinical ServicesTIME COMPLETED:
03:15 PM
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On 03/01/2024 at 8:00 am Licensing Program Analyst (LPA) David España conducted an unannounced annual inspection visit at the Epi Center. Upon arriving at the facility, LPA España met with the Program Manager Morgan Dye and Shir Dyer, Director of Programming and Clinical Services assisted with the visit.

The purpose of today’s visit was discussed. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA España was granted access and allowed to enter the facility to conduct inspections. The Adult Day Program (ADP) facility is licensed to serve 25 developmentally disabled clients ages 18, years and above. Facility approved for 15 non-ambulatory and 10 ambulatory clients. LPA España and Program Manager Morgan Dye 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 includes: a large multipurpose room, two (2) restrooms, a changing room, relaxation room, music room, art room, storage room, two (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. Toilets and water faucets worked properly; grab bars were secure, comfortable temperature was maintained in the facility. Continued 809-c
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: EPI CENTER
FACILITY NUMBER: 198200792
VISIT DATE: 03/01/2024
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All clients bring their own lunch. Hazardous items are inaccessible to clients and kept in a storage cabinet. First aid kit is fully stocked. Medications are centrally stored in a locked cabinet in the Program Director office.LPA España observed three (3) fully charged fire extinguishers which were inspected. LPA España toured the kitchen area and observed the refrigerator and on-site washer/dryer. During the visit, LPA España observed infection control practices. LPA España observed a sanitizing station at the facility entry with visitors logs and temperature checks. Sanitizer/soap, paper towels are in all the bathrooms and additional sanitation supplies are stored in staff office. LPA España observed staff wearing masks and was shown in the isolation area. LPA España observed trash cans with lids and required postings throughout the facility. Emergency contacts updated and posted; PPE's are enough for 30 days. 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 on today’s visit.

An exit interview was conducted and a copy of this report was provided to Shir Dyer, Director of Programming and Clinical Services.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC809 (FAS) - (06/04)
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