198203104-5-15-2026-11-AS-ZBRN-DU4TF5-20260515144057

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198203104
Report Date: 05/15/2026
Date Signed: 05/15/2026 02:41:08 PM

Document Has Been Signed on 05/15/2026 02:41 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:	PERFORMING ARTS STUDIO WEST		FACILITY NUMBER:	198203104
ADMINISTRATOR/ DIRECTOR:	JOHN PAIZIS		FACILITY TYPE:	775
ADDRESS:	438 S. MARKET STREET		TELEPHONE:	(310) 674-1346
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90301
CAPACITY: 60		CENSUS: 24	DATE:	05/15/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Lisa Chapman (Assistant Director of Support Services)		TIME VISIT/ INSPECTION COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 09:15am, the Department conducted an unannounced visit to conduct an annual inspection. The Department met with Lisa Chapman (Assistant Director of Support Services) and explained the purpose of the visit. The Assistant Director of Support Services stated that the facility has (90) clients currently enrolled in the program: (88) ambulatory and (2) non-ambulatory. The staff to client ratio is (1) one staff to (5) five clients with none of the clients having restricted health care conditions or utilize any protective devices. The program does not provide transportation. The Adult Day Program is located in a single-story commercial building hours of operates between the hours of 9am - 2:00pm, Monday - Friday. All clients bring their own lunch; however, if a client forgets their lunch, facility staff provide emergency food while out in the community. Between the hours of 9:28am - 9:45am, the Department and Assistant Director of Support Service Lisa Chapman toured the entire Adult Day Program and observed the following Acting Classes Studio with a Green Room, Recording Studio, Post-Production Office, Dance Studio, Music Room, Administrative Office, staff lounge/break room, multi-purpose room, lunch/locker areas, Support Office, four (4) bathrooms, storage closet area, and a gated parking lot next door with twelve (12) parking spaces rented by the ADP. The water temperature properly measured between 105°F -120°F degrees (water tested at 111.5°F ). Carbon monoxide detectors, smoke detectors, and fire extinguishers were fully charged and operational ; with the last Fire/Emergency Drill was conducted on 04/27/2026 by Securita Technology. Bathrooms were clean and functional, hazardous items were inaccessible to clients, and the first aid kit was fully stocked. The day program grounds were free of debris and hazards. Report continues on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Zina Brown
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: PERFORMING ARTS STUDIO WEST	FACILITY NUMBER: 198203104
	VISIT DATE: 05/15/2026

NARRATIVE

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Between the hours of 10:00am - 1:45pm, the Department conducted a records review of nine (9) client files, five (5) staff files and the Department observed any discrepancies at the time of visit. The day program currently has no clients on medications; however, a designated locked cabinet is available for medication storage. No personal/incidental monies are handled by day program staff.

Deficiencies cited under California Code of Regulations Title 22, Division 6, Chapter 3.

Based on observation & records review the Department observed the following:
Expired CPRs for 6 out of 6 staff
No current IPPs for 8 out of 9 clients

Exit interview conducted with Lisa Chapman (Assistant Director of Support Services) and copy of this report with appeals was provided.

NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Zina Brown
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/15/2026 02:41 PM - It Cannot Be Edited

Created By: Zina Brown On 05/15/2026 at 02:08 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: PERFORMING ARTS STUDIO WEST	FACILITY NUMBER: 198203104
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82075(f)

Health-Related Services

(f) Staff responsible for providing direct care and supervision shall receive and maintain current training in first aid and cardiopulmonary resuscitation from persons qualified by agencies including, but not limited to, the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and records review, the licensee did not comply with the section cited above for 6 out of 6 staff which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/29/2026
	Plan of Correction
1 2 3 4	The facility will submit the proof of correction to the CCLD/El Segundo ASC Office via fax at 424-544-1016 Attn: Zina Brown or via email at zina.brown@dss.ca.gov by the POC due date.

Type B

Section Cited

CCR

82068.2(d)

Needs and Services Plan

(d) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above for 8 out of 9 clients which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/29/2026
	Plan of Correction
1 2 3 4	The facility will submit the proof of correction to the CCLD/El Segundo ASC Office via fax at 424-544-1016 Attn: Zina Brown or via email at zina.brown@dss.ca.gov by the POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Janae Hammond
NAME OF LICENSING PROGRAM MANAGER:

	Zina Brown
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

LIC809 (FAS) - (06/04)

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