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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320147
Report Date: 11/03/2021
Date Signed: 11/03/2021 01:43:42 PM

Document Has Been Signed on 11/03/2021 01:43 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
MONTEREY PARK, CA 91754
FACILITY NAME:ICAN CALIFORNIA ABILITIES NETWORK LONG BEACHFACILITY NUMBER:
198320147
ADMINISTRATOR:ELLIOTT, SCOTTFACILITY TYPE:
775
ADDRESS:4200E.PACIFIC COAST HWY.STE200TELEPHONE:
(310) 374-8295
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY: 18CENSUS: DATE:
11/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
01:45 PM
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On 11/03/21 Licensing Program Analyst (LPA) Jade Jordan made an unannounced visit to Ican California Abilities Network (ADP) located in 4200 E Pacific Coast Hwy Ste 200 Long Beach Ca. The purpose of today's visit was to conduct a 1 year inspection of the facility, with an emphasis on infection control. On today's visit LPA met with facility Program Manager, Claire "Cal" Calica. The facility profile shows that the facility is licensed for a capacity of 18. The Program Manager stated that the facility has 24 consumers enrolled on site, broken up into pods of 12, on days of Monday /Wednesdays, and Tuesday/Thursdays. A total of 3 consumers enrolled virtually Monday -Friday, during normal working hours.

Upon entry LPA was screened for Covid-19 using a touchless questioner, accessed by smart phone, temperature was taken, and hand sanitizers provided. LPA Observed infection control measures set in place, and observed over the minimum of 30 day supply of PPE's. PPE's observed were face shields, gowns, gloves, surgical masks, N95's, sanitizer and hand soap.

As a part of today's inspection LPA reviewed 5 consumer records, 4 staff records, and inspected the entire facility inside and out. The property consists of 1 large building, the structure consists of the following: A front Lobby, three (3)staff offices , (3) conference rooms, locker room for clients to store belongings, 4 multipurpose activity rooms, with required furnishings, a kitchen that will be used for activities. 2 Gender assigned full restrooms, 1 men’s and 1 women’s restroom, and 1 Non-Gender assigned restroom.

SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2021
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
MONTEREY PARK, CA 91754
FACILITY NAME: ICAN CALIFORNIA ABILITIES NETWORK LONG BEACH
FACILITY NUMBER: 198320147
VISIT DATE: 11/03/2021
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Facility walls and floors were in good condition, adequate lighting, fire extinguishers were properly charged. Plenty of storage space and chemicals were properly locked. The men's and women's restrooms were clean and within Title 22 regulations. A water dispenser was available for consumer use. The kitchen was clean and a refrigerator was available for consumer use. The day program does not provide lunch, however emergency snacks/meals were available to consumers. The first aid kit was available, Walkways throughout the day program were clear of hazards and all exits were clear of debris.

Exit interview conducted and a coy of this report provided. No citations issued during this visit .

SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC809 (FAS) - (06/04)
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