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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320457
Report Date: 07/31/2024
Date Signed: 08/06/2024 11:19:00 AM

Document Has Been Signed on 08/06/2024 11:19 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:NEW VISION DAY PROGRAM, INC.FACILITY NUMBER:
198320457
ADMINISTRATOR/
DIRECTOR:		LOVE, TERRYNEFACILITY TYPE:
775
ADDRESS:336 E KELSO STTELEPHONE:
(310) 419-9240
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY: 35CENSUS: 13DATE:
07/31/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:56 PM
MET WITH:Terryne Love TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 07/31/24, Licensing Program Analysts (LPAs) Ernand Dabuet and Hollie Enriquez conducted announced visit to this faciltiy. LPAs was greeted by applicant Terryne Love and explained the purpose of today’s pre-licensing inspection visit.

An application was submitted to CCLD on 07/05/24 in the initial license application for an Adult Daycare Program, ages 18-59. The applicant requested a capacity of twenty-nine (29) individuals, of which maybe six (6) non-ambulatory.

Structure:
The day program consist of three (3) administrative offices, one (1) kitchen, three (3) classrooms, one (1) meeting room, three (3) common bathrooms and (1) private bathroom. The lobby area included a sofa and and coffee table. The kitchen has a refrigerator and stove. The rear exterior is fenced throughout. The passageways, walkways, and steps are free from obstructions.

Bathrooms:
The day program has three (3) common bathrooms. Bathrooms are accessible to all rooms. All bathrooms have a working toilets and washbasin.

Emergency Phone Numbers, Exit Plan:
Emergency phone numbers. The exit plan are posted and readily available for review throughout the facility. There are two (2) fire extinguisher and (2) hand held portable extinguishers in the office. A telephone line is available. Emergency supplies and Personal Protective Equipment supplies are stored in the supply room. The applicant submitted an approved Infection Control Plan.

Evaluation Report Continues
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024
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: NEW VISION DAY PROGRAM, INC.
FACILITY NUMBER: 198320457
VISIT DATE: 07/31/2024
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Food Service:
Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked closet.

Smoke Detectors:
Smoke and carbon monoxide detectors throughout the interior space. Smoke detectors in (3) classrooms,(3) offices, lobby area and hallways. Carbon monoxide is available in classrooms.

Toxins:
All toxins are locked and stored in a locked closet.

Appliances:
Stove burners are working. There is one (1) refrigerator in the kitchen are. The refrigerator appropriate food storage. The facility is equipped with central air and heating.

Water Temperature:
The water temperature was at 105.0 degrees F.

Medications, First-Aid Kit & Book:
A first aid kit is stored in a metal cabinet inside the office The consumer's medications are stored in the meeting room in a locked wall cabinet inaccessible to consumers.

Resident & Staff Files:
Records of staff and consumers files are stored in administrative offices in a locked metal cabinet

Reading Material, Games, Equipment & Materials:
A variety of games and reading materials including desktop computers are available.

Evaluation Report Continues
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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: NEW VISION DAY PROGRAM, INC.
FACILITY NUMBER: 198320457
VISIT DATE: 07/31/2024
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Fire clearance:
A Fire Clearance inspection was conducted on 06/14/24 approved for a capacity for twenty-nine (29) ambulatory, six (6) non- ambulatory, and zero (0) for bedridden.

Component III:
LPA Enriquez conducted the Pre-Licensing inspection along with the information provided about how to operate the facility within substantial compliance with Component III PowerPoint.

LPAs Dabuet and Enriquez observed the following corrections:
  • Staff #1 did not have a Health Screening & TB Test Results on file. - Corrected 08/06/24
  • Fire Extinguisher in Kitchen Area is not fully charged - Corrected 08/06/24

An exit interview was conducted, and a copy of this report has been furnished to the applicant, Terryne Love LPA Dabuet 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 their application.

End of Report
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC809 (FAS) - (06/04)
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