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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320147
Report Date: 09/06/2022
Date Signed: 09/06/2022 01:33:11 PM

Document Has Been Signed on 09/06/2022 01:33 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: 16DATE:
09/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:ADMINISTRATOR CLAIRE ROATIME COMPLETED:
02:00 PM
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On 09/06/2022 at 10:00 AM Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced Annual required visit ICAN California Abilities Network Long Beach Facility with a primary focus on infection control measures. LPA Calderon was met by Administrator Claire Roa and the purpose of today’s visit was explained. The facility is licensed to serve 18 adult clients with behavioral issues.
There are currently 16 clients in care all clients are ambulatory. The facility is a one-story structure with (20) rooms and (3) bathrooms, activity room. kitchen and work out room, teaching rooms, computer room and staff offices.
LPA Calderon and Administrator Claire Roa toured the physical plant. There is no bodies of water or firearm/ammunition on the premises. All client rooms were checked and are in good condition and well maintained. LPA Calderon noted adequate lighting was provided to staff and clients, storage for client personal belongings was observed. Walls and floors were in good repair. All equipment, computers, work stations are well maintained and there is adequately PPE stocked at the time of visit. LPA Calderon observed Bathrooms were found to be within Title 22 regulations and were clean and operational. LPA Calderon noted the following: Bathroom #1 hot water temperature properly measured at 102 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 103 degrees Fahrenheit, and bathroom #3 hot water temperature properly measured at 105 degrees Fahrenheit, and finally the Kitchen hot water temperature properly measured at 107 degrees Fahrenheit. LPA Calderon observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were not accessible to clients. The facilities’ last fire drill was conducted by staff on 03/03/2022. LPA Calderon noted (13) Smoke detectors all were hard wired, (2) Carbon Monoxide was found in the facility. The facility (6) Fire Extinguishers were checked and found to be fully charged and accessible. Three (3) clients files were reviewed and found to be complete. LPA Calderon reviewed (3) client’s medications and they were all found to be administered according to doctor's orders. Two (3) staff files were checked and have the required documents. The facility does not handle client’s money/cash resources. All the required documents are posted in the facility in a visible area to staff and clients.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2022
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: 09/06/2022
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During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon did observe screening protocols for visitors, staff and clients, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff were wearing face coverings, an isolation room is confirmed for the facility. LPA Calderon observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPA Calderon advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.



During today’s visit there were no deficiencies under California code of regulation title 22, division 6, chapter 8. Exit interview and copy of the report was provided to Administrator Claire Roa.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
LIC809 (FAS) - (06/04)
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