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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320102
Report Date: 01/19/2023
Date Signed: 01/19/2023 10:56:15 AM

Document Has Been Signed on 01/19/2023 10:56 AM - 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, 1000 CORPORATE DR #100
MONTEREY 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: 18DATE:
01/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Silas Cole/Scott Elliott/Louise ElliotTIME COMPLETED:
11:15 AM
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On 1/19/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA called to conduct a risk assessment and spoke with Regional Director Scott Elliot who confirmed the day program is free of Covid-19 infection. LPA met with Program Manager Silas Cole, and LPA explained the purpose of the visit. Regional Director Scott Elliott and Administration Director Louise Elliot arrived later and joined the visit.

The facility is located in a single-story commercial building and consists of the following rooms: a reception area; a large main space/lunchroom with tables and chairs, employees breakroom, clients breakroom, waiting lounge; 3 conference rooms, art room, kitchen, 3 activity rooms; janitor’s closet; locked storage room; 4 restrooms; case managers office; program managers office and a large open locker room with 96 lockers for both staff and clients.

The day program is licensed to operate for eighteen (18) developmentally disabled clients, ages 18 and over, of which four (4) may be non-ambulatory. There were eighteen (18) clients, thirteen (13) direct support staff, four (4) executive administration staff and nine (9) office staff at the time of the visit. The Adult Day Program (ADP) sessions are every morning from 8:30 am-1:30 pm and afternoon from 2:00 pm – 6:00 pm.

LPA and Program Manager Silas Cole toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected and had adequate lighting and furnishings. Bathrooms were found to be within Title 22 regulations and were clean and operational. A comfortable temperature was maintained in the facility. There are four (4) fire extinguishers last serviced on 9/9/2022. The last fire drill was conducted on 10/20/2022. Smoke alarm system was tested and found to be operable. The water temperature was within Title 22 regulations.

Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ICAN CALIFORNIA ABILITIES NETWORK TORRANCE
FACILITY NUMBER: 198320102
VISIT DATE: 01/19/2023
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Medications are locked & centrally stored in a locked room. The first aid kit has all required supplies.

During the visit, LPA observed the following to be in compliance: the facility's infection control practices; screening protocols for visitors, staff, and clients, sanitizing stations in common areas and restrooms; every staff was wearing a face covering; facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD. LPA reviewed the day program's Certificate of Liability which indicates a coverage of 1,000,000.00 per occurrence and 3,000,000.00 per general aggregate. The policy is effective 5/1/2022 through 5/1/2023.

No deficiencies cited.

Exit interview conducted and a copy of this report was provided to the Program Manager Silas Cole.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC809 (FAS) - (06/04)
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