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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320316
Report Date: 11/15/2022
Date Signed: 02/14/2023 02:52:22 PM

Document Has Been Signed on 02/14/2023 02:52 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:NORTH TORRANCE INCLUSION CENTERFACILITY NUMBER:
198320316
ADMINISTRATOR:RODRIGUEZ, ANGELA PONCEFACILITY TYPE:
775
ADDRESS:3515 ARTESIA BLVD.TELEPHONE:
(310) 944-3303
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 21CENSUS: 0DATE:
11/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Regional Director Lesly Rovelo and Director of Regional Administration Angela RodriguezTIME COMPLETED:
03:16 PM
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On February 14, 2020 at 9:30 a.m., Licensing Program Analyst Jeremiah Randle conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA met with Regional Director Lesly Rovelo and Director of Regional Administration Angela Rodriguez who accompanied LPA inside and outside the facility during today’s inspection.

An application was submitted to CCLD on 06/22/2022, for Initial license for an Adult Day Program to serve developmentally disabled clients 18 years and above. The requested capacity is for 21 of which 6 may be non-ambulatory.

Structure: The facility is located in is a single story commercial building and consists of a receptionist area, 15 staff offices, 2 conference rooms, a supply room, an employee break room, a fitness room, a leisure room/ multi-purpose room, a computer room, 4 rest-rooms, a kitchen, an arts and crafts room, a salon, 2 storage rooms, a quiet room, and a clients locker area. The building and grounds are free from hazards, passageways and doors are not blocked or obstructed.

Restrooms: All 4 restrooms have wash basins, toilets and are equipped with grab bars. Water Temperature: Tested within Title 22 limits.

Appliances: Televisions, Stove, oven, microwave, refrigerator, and dishwasher are clean and in good repair.

Reading Material, Games, Equipment & Materials: The facility has computers, board games, books, and other recreational materials for the client's use, commensurate with the plan of operation.

Food Service: Dishes, cups and flats are stored in the kitchen cupboards, inspected and are in clean and sanitary condition. Knives, cutlery, and other sharp kitchen utensils are stored in locked drawers next to the sink.

Toxins: Locked/stored in storage rooms, cabinets and drawers locked and inaccessible to clients in care.

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SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: NORTH TORRANCE INCLUSION CENTER
FACILITY NUMBER: 198320316
VISIT DATE: 11/15/2022
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Medications, First-Aid Kit & Book: A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in the case manager's office, available for staff use but inaccessible to clients.

Emergency Disaster Plan, Personal Rights and Complaint Procedures: Are posted & readily available for review in the staff lounge. 4 Fire Extinguishers are located throughout the facility and in the kitchen, all are properly charged.

Smoke Detectors: Smoke detectors, are installed throughout the facility in all program rooms, hallways and are hard wired & connected. Facility has a fire sprinkler system throughout the facility.

Clients & Staff Files: Applicant will not be handling cash resources of clients. Records of staff and clients will be stored in a locked cabinet and the section has been inspected along with the available records present. Located in the administrator and case managers offices.

Pool/Jacuzzi & Pets: None.

Fire clearance: Fire Clearance for 15 ambulatory and 6 non-ambulatory total capacity of 21 was approved on 07/20/22.

LPA received a copy of Certificate of Liability Insurance for the facility.

Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance.

An exit interview was conducted, and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to the applicant.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC809 (FAS) - (06/04)
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