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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320388
Report Date: 09/20/2024
Date Signed: 09/20/2024 02:28:54 PM

Document Has Been Signed on 09/20/2024 02:28 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 REDONDO BEACHFACILITY NUMBER:
198320388
ADMINISTRATOR/
DIRECTOR:		ELLIOTT, SCOTTFACILITY TYPE:
775
ADDRESS:2761 W. 190TH STREETTELEPHONE:
(310) 374-8295
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90278
CAPACITY: 45CENSUS: 41DATE:
09/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:36 AM
MET WITH:Licensee/ Scott Elliott and Director/Louise ElliotTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 09/20/2024 at around 8:30 AM, Licensing Program Analyst (LPA) Hollie Enriquez conducted an unannounced Required – 1 Year Inspection to the above-named facility and initially met with Licensee/Scott Elliott and later joined with Director/Louise Elliott and explained the purpose of the visit. This facility is licensed to serve clients ages 18 years and above. The fire clearance has been approved for 45 ambulatory clients, of which 10 may be non-ambulatory. Currently the facility serves 41 clients all receiving services through various Regional Centers, of which 33 are ambulatory and 8 are non-ambulatory.

The Annual Licensing Fee was paid today 09/20/2024 and the online payment confirmation number is: 945926

Licensee Elliott toured LPA through the inside and outside of the facility grounds. The facility is a one-story commercial building located on a main street. The facility consists of an a medication/supply room, 2 office spaces, conference room, art room, 3 activity rooms, computer lab, resting/quiet room for clients, 3 restrooms, staff break room, an outdoor activity area with seating, chairs and outdoor games, and a large parking lot.




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SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Hollie Enriquez
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 REDONDO BEACH
FACILITY NUMBER: 198320388
VISIT DATE: 09/20/2024
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Walkways around the building were clear of hazards. There are no security bars or weapons on the premises. LPA toured the kitchen area that is used for the cooking club programs and snacks; program does not provide cooked meals. LPA observed knives and toxins kept in locked storage cabinet. Medications are stored and locked in the medication room. There are landline phones on the premises and video conferencing devices dedicated for client use.

Documents are posted as mandated. Last Fire Drill was conducted on 05/12/2024 and last Earthquake Drill was conducted on 08/12/2024. The facility had their Annual Fire Inspection on 08/05/2024. First aid kit is fully stocked with manual. Fire extinguishers located throughout the premises were fully charged and last serviced on 03/11/2024. Water temperature in the client restrooms measured 106.7-107.1 degrees Fahrenheit.

10 staff records were reviewed and 10 out of 10 staff records met regulation requirements. 9 client records were reviewed and, 9 out of 9 client records had required documentation.

Based on LPA observation and record review in accordance with the California Code of Regulations, Title 22 a Technical Violation has been issued.

LPA observed clients C4, C8, and C9 did not have a Regional Center IPP that was within a year. Director has agreed to maintain documentation of requests to Regional Center for the current IPP in the event that current IPP's have not been recieved.

An exit interview has been conducted and a copy of this report has been provided to Director Louise Elliott.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Hollie Enriquez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC809 (FAS) - (06/04)
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