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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320102
Report Date: 01/15/2021
Date Signed: 02/14/2022 03:22:18 PM

Document Has Been Signed on 02/14/2022 03:22 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:ICAN CALIFORNIA ABILITIES NETWORK TORRANCEFACILITY NUMBER:
198320102
ADMINISTRATOR:COLE, SILASFACILITY TYPE:
775
ADDRESS:2375 SEPULVEDA BLVDTELEPHONE:
(310) 374-8295
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 18CENSUS: 0DATE:
01/15/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:SCOTT ELLIOTTTIME COMPLETED:
05:00 PM
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On January 15, 2021 at 2:00 pm, Licensing Program Analyst (LPA) Lourdes Montoya conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA virtually met with Executive Director, Scott Elliott, who showed the inside and outside of the facility. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted telephonically via Zoom.

An application was submitted to CCLD on 10/1/2020, for Initial license for an Adult Day Program to serve developmentally disabled clients 18 years and above. The requested capacity is for 18 of which 5 may be non-ambulatory.

Structure: The facility is located in is a single story commercial building and consists of the following rooms: a receptionist area; a large lunch room with table and chairs; employees breakroom; clients breakroom; a waiting lounge; 3 conference rooms; art room; kitchen; 4 activity rooms; janitor’s closet; locked storage room; 4 restrooms; case managers office; program managers office and a large locker room with 92 lockers for both staff and clients.

The building and grounds are free from hazards, passageways and doors are not blocked or obstructed.

Restrooms: All 4 restrooms have wash basins, toilets and are equipped with grab bars.

Water Temperature: Tested at 114.8 degrees Fahrenheit in the art room; 114.1 in the kitchen; and 112.5 in one of the bathrooms near the kitchen.

Appliances: Televisions, Stoves, ovens, microwaves, refrigerators and dishwasher are clean and in good repair.

Reading Material, Games, Equipment & Materials: The facility has iMac computers, iPads, board games, books, and other recreational materials for the client's use, commensurate with the plan of operation.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2021
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: ICAN CALIFORNIA ABILITIES NETWORK TORRANCE
FACILITY NUMBER: 198320102
VISIT DATE: 01/15/2021
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Food Service: Due to the current Covid pandemic, the program will use disposable dishes, cups and utensils. Knives, cutlery and other sharp kitchen utensils are stored in locked storage box in a locked room.

Toxins: Stored in a storage room, locked and inaccessible to clients in care.

Medications, First-Aid Kit & Book: A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in the storage room, available for staff use but inaccessible to clients. All staff have the access code to the storage room.

Emergency Disaster Plan, Personal Rights and Complaint Procedures: Are posted & readily available for review in the staff breakroom. 4 Fire Extinguishers are located in the main lobby, posted in a wall in the kitchen, under the sink in the kitchen and near exit door.

Smoke Detectors: Smoke detectors, are installed in all program rooms and hallways and are Electrical & connected. There are 4 carbon monoxide in the locker room, kitchen, janitor’s closet, and staff breakroom.

Clients & Staff Files: Applicant will not be handling cash resources of clients. Records of clients will be stored in a locked drawer in case managers office; staff files will be stored in a locked cabinet in HR’s office.

Pool/Jacuzzi & Pets: None.

Fire clearance: Fire Clearance for 13 ambulatory and 5 non-ambulatory total capacity of 18 was approved on 10/1/2020.

Component III: was waived due to applicant having licensed facilities of the same category, ADP, by community care licensing division. Mr. Scott Elliott has completed the Component III on 10/16/2020.

An exit interview was conducted, and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to the applicant.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2021
LIC809 (FAS) - (06/04)
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