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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320147
Report Date: 11/08/2024
Date Signed: 11/08/2024 01:29:30 PM

Document Has Been Signed on 11/08/2024 01:29 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:ICAN CALIFORNIA ABILITIES NETWORK LONG BEACHFACILITY NUMBER:
198320147
ADMINISTRATOR/
DIRECTOR:
CLAIRE ROAFACILITY TYPE:
775
ADDRESS:4200E.PACIFIC COAST HWY.STE200TELEPHONE:
(310) 374-8295
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY: 18CENSUS: 18DATE:
11/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:32 AM
MET WITH:Program Director Louise ElliotTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On 11/08/2024 Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced Annual required visit ICAN California Abilities Network Long Beach Facility using the CARE Tool. LPA met with Program Director Louise Elliot as the purpose of today’s visit was explained. The facility is licensed to serve 18 ambulatory adult clients of which four may be non-ambulatory. Clients are linked to the harbor regional center. Facility fees are current.

The facility is a single story structure with a lobby, main space/common area, (3) offices, a kitchen with a seating area, (4) client work rooms, a large conference room, and a locker room for client belongings. Clients bring their own lunches to the program. All rooms were checked and are in good condition, furnished, and well maintained. LPA observed adequate lighting throughout the facility, walls and floors were clean and in good repair. All equipment, computers, work stations are well maintained. Bathrooms were found to be within Title 22 regulations. Water temperature measured between 105-120 degrees Fahrenheit. Storage areas for cleaning agents, toxins, and sharp objects were not accessible to clients. The facilities last fire drill was conducted on 05/14/2024, LBFD fire inspection was conducted on 01/29/24 .Smoke detectors are interconnected and operational. First aid kit is fully stocked with manual. There is no bodies of water or firearm/ammunition on the premises.

LPA conducted a review of 6 client files and 4 staff files, no discrepancies were observed.

Exit interview conducted with Program Director Louise Elliot, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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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