198320388-9-19-2023-11-AS-RCLD-CVTPTH-20230919113559

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320388
Report Date: 09/19/2023
Date Signed: 09/19/2023 11:36:23 AM

Document Has Been Signed on 09/19/2023 11:36 AM - 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 REDONDO BEACH		FACILITY NUMBER:	198320388
ADMINISTRATOR:	ELLIOTT, SCOTT		FACILITY TYPE:	775
ADDRESS:	2761 W. 190TH STREET		TELEPHONE:	(310) 374-8295
CITY:	REDONDO BEACH	STATE: CA	ZIP CODE:	90278
CAPACITY: 45		CENSUS: 43	DATE:	09/19/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:54 AM
MET WITH:	Scott and Louise Elliot		TIME COMPLETED:	11:35 AM

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On 09/19/2023 Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Regina Cloyd conducted an announced visit to the facility for purpose of a pre-licensing evaluation. Today’s pre-licensing evaluation was conducted with applicant Scott and Louise Elliot.

On March 23, 2023 an application was submitted to CCLD, for a change of ownership license at an Adult Day Program to serve adults age range 18 through 59. The requested capacity is for forty-five (45) clients of which ten (10) may be non-ambulatory clients. The facility has: (4) Activity Rooms, (2) Bathrooms, (2) Offices, (1) Conference Room, (1) Storage Room, (1) Kitchen, (1) Computer Lab, and (1) Client Break Room.

LPM and LPA conducted a review of the Medications, Physical Plant, Supplies, Food Service, Records, Administration, Activities, Pe-Licensing Checklist and Component III Orientation.

MEDICATIONS

There is a locked centralized storage area for client medications.

PHYSICAL PLANT

Facility is clean, sanitary, and in good repair. Indoor and outdoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Stairways, inclines, ramps, open porches, and areas of potential hazard are equipped with sturdy hand railings. Carbon monoxide detectors operate properly.

BATHROOMS

Hot water temperature is 109.2 degrees Fahrenheit.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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 REDONDO BEACH	FACILITY NUMBER: 198320388
	VISIT DATE: 09/19/2023

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SUPPLIES

There are client personal hygiene supplies to include soap and toilet paper.

FOOD SERVICE

Refrigerator(s) and freezer(s) are clean and large enough for storage. Freezer is 0 degrees Fahrenheit. Refrigerator is a maximum of 45 degrees Fahrenheit. There are sufficient amounts of equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean.

RECORDS

There is confidential storage of personnel records at the facility. There is confidential storage of client records at the facility.

ADMINISTRATION

The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted.

ACTIVITIES

is an outdoor activity space with a shaded area and furnished for outdoor use. There are activity supplies to include newspapers, magazines, and a variety of reading material.

MISCELLANEOUS

There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is an operating telephone available to clients. Vehicle used to transport clients are in safe operating condition.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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 REDONDO BEACH	FACILITY NUMBER: 198320388
	VISIT DATE: 09/19/2023

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COMPONENT III

Provided in-person, information was provided about how to operate the facility within substantial compliance.

During the prelicensing inspection there were no items observed which do not comply with applicable laws and regulations.

An exit interview was conducted, and a hard 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: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC809 (FAS) - (06/04)

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