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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320147
Report Date: 12/18/2023
Date Signed: 12/18/2023 12:30:30 PM

Document Has Been Signed on 12/18/2023 12:30 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ICAN CALIFORNIA ABILITIES NETWORK LONG BEACHFACILITY NUMBER:
198320147
ADMINISTRATOR:CLAIRE ROAFACILITY TYPE:
775
ADDRESS:4200E.PACIFIC COAST HWY.STE200TELEPHONE:
(310) 374-8295
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY: 18CENSUS: 17DATE:
12/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Executive Director Scott ElliotTIME COMPLETED:
12:45 PM
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On 12/18/2023 at 9:17 AM Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Annual required visit ICAN California Abilities Network Long Beach Facility using the CARE Tool. LPA Cloyd met with Staff #1 and explained the purpose of today’s visit was explained. The Executive Director Scott Elliot joined us 30 minutes later. The facility is licensed to serve 18 ambulatory adult clients of which four may be non-ambulatory.

There are currently 17 clients in care. The facility is a one-story structure with (3) bathrooms, lobby, (3) offices, main space, kitchen, client break room, (4) client work rooms, small and large conference room, and locker room.

LPA Cloyd and Staff #1 toured the physical plant. There is no bodies of water or firearm/ammunition on the premises. All rooms were checked and are in good condition, furnished, and well maintained. LPA Cloyd noted adequate lighting was provided to staff and clients and storage for client personal belongings was observed.

Walls and floors were in good repair. All equipment, computers, work stations are well maintained. LPA Cloyd observed bathrooms and they were found to be within Title 22 regulations. The temperature in the gender neutral bathroom measured at 105.2 degrees Fahrenheit. Storage areas for cleaning agents, toxins, and sharp objects were not accessible to clients. The facilities’ last fire drill was conducted on 12/18/2023. Smoke detectors are interconnected and operational. First aid kit is fully stocked with manual.

Continue to LIC 809-C.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2023
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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ICAN CALIFORNIA ABILITIES NETWORK LONG BEACH
FACILITY NUMBER: 198320147
VISIT DATE: 12/18/2023
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Five (5) clients files were reviewed and found to be complete. The facility does not handle client’s money/cash resources. Three clients were interviewed.

Five (5) staff files were checked and have the required documents. Three staff members were interviewed.

All the required documents are posted in the facility in a visible area to staff and clients.

No deficiencies cited.

An exit interview was conducted. A copy of this report was left with the Executive Director.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
LIC809 (FAS) - (06/04)
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