198320316-1-29-2024-11-AS-WGIS-CZY3JQ-20240129171756

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320316
Report Date: 01/29/2024
Date Signed: 01/29/2024 05:18:04 PM

Document Has Been Signed on 01/29/2024 05:18 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:	NORTH TORRANCE INCLUSION CENTER		FACILITY NUMBER:	198320316
ADMINISTRATOR:	RODRIGUEZ, ANGELA PONCE		FACILITY TYPE:	775
ADDRESS:	3515 ARTESIA BLVD.		TELEPHONE:	(310) 944-3303
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY: 21		CENSUS: 3	DATE:	01/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Daniel Morales		TIME COMPLETED:	05:00 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On 01/29/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit to the facility listed above. LPA met with Program Director, Daniel Morales, and the purpose of today’s visit was explained. The facility is licensed to serve developmentally disabled client’s aged 18 and over. The facility is approved for 21 ambulatory clients, 6 of which may be non-ambulatory. During the time of visit there were 3 clients present.

Physical Plant/Structure The facility is a single-story commercial building that consist of a reception area, 15 staff offices, 3 conference rooms, supply room, employee break room, fitness room, leisure room, computer room, arts and crafts room, salon, quiet room, 3 storage rooms, kitchen, music rooms, 4 bathrooms, and locker room. LPA observed all walkways, hallways, and doorways to be clean, clear, and free of obstructions, hazards, and debris.

Rooms LPA inspected all activity rooms and found them to be clean and in good repair. All rooms were observed to be properly furnished. LPA observed an ample supply of reading material, activities, crafts, games, and other recreational materials for clients use. All rooms have ample lighting. The facility was maintained at a comfortable temperature.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 3 of 7

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: NORTH TORRANCE INCLUSION CENTER	FACILITY NUMBER: 198320316
	VISIT DATE: 01/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Bathroom LPA inspected the Men’s, Women’s, and two (2) unisex restrooms and found them to be operational, clean, and sanitary. All bathrooms have secured safety handrails. The water temperature measured 11 3.1-degrees, 110.1-degrees, 111.1-degrees and 111.4-degrees Fahrenheit.
Kitchen LPA observed the kitchen to be clean and sanitary. All appliances were observed in good working repair. LPA observed an ample supply of cookware, dishware, and cutleries. LPA observed a 7-day supply of non-perishable foods. All knives and sharps are secured in a locked drawer and are inaccessible to clients. All cleaning supplies and toxins are secured in a locked storage room and are inaccessible to client. The water temperature measured 114.2-degrees Fahrenheit. Files & Interviews LPA reviewed the files for four (4) clients and observed they contained the required documents. LPA interviewed three (3) residents, and they were happy with the services and care they receive at the facility. LPA reviewed the Program Director file and two (2) staff files and found they contained the required documents, training, and certification. LPA interviewed two (2) staff, two (2) out of two (2) were able to explain policy, procedure, and resident rights.
Medications Currently the facility does not have any clients receiving medications. In the Executive Directors office is a locked medication box.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: NORTH TORRANCE INCLUSION CENTER	FACILITY NUMBER: 198320316
	VISIT DATE: 01/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Safety LPA observed smoke and carbon monoxide detectors throughout the facility in all program rooms and hallways and are hard wired & connected. The facility has a fire sprinkler system throughout the facility. The smoke detector and fire sprinkler system were last inspected by the Torrance Fire Department on 02/14/23. LPA observed two additional carbon monoxide detectors in the facility. LPA observed four (4) fully charged fire extinguishers last serviced on 06/29/23. All exits are clearly marked, and facility sketches are posted throughout the facility indicating the exit route. The emergency drill was conducted on 12/22/23. LPA observed all required postings throughout the facility. The facility has a working landline telephone.
Infection Control LPA observed sanitizing stations throughout the facility. LPA observed required infection control signs posted throughout the facility. LPA observed a 60-day supply of Personal Protective Equipment (PPE).

LPA did not observe or site any deficiencies.

An exit interview was conducted with Program Director, Daniel Morales, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC809 (FAS) - (06/04)

Page: 7 of 7