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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320484
Report Date: 05/30/2024
Date Signed: 05/30/2024 12:27:06 PM

Document Has Been Signed on 05/30/2024 12:27 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:ACHIEVING RESULTS TOGETHERFACILITY NUMBER:
198320484
ADMINISTRATOR/
DIRECTOR:		PRODANOVICH, KATIEFACILITY TYPE:
775
ADDRESS:3841 ATLANTIC AVETELEPHONE:
(562) 846-0493
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: 30CENSUS: 0DATE:
05/30/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:14 AM
MET WITH:Katie Prodanovich, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 05/30/24 Licensing Program Analyst (LPA) Mario Leon conducted a pre-licensing visit for an Adult Day Program type facility for the above-mentioned facility. LPA was met by certified Administrator/Program Manager Katie Prodanovich (S1).
The licensee has applied for a license to serve 30 adult clients, aged 18 and older, with fire clearance granted for 15 non-ambulatory clients.
The facility is a single-story building, located in a business district in Bixby Knolls. A tour of the facility was conducted and consists of the following: three (3) classrooms, one (1) therapy/relaxation room, 1 observation room attached to the therapy room equipped with one-way glass, 1 staff office, 1 community/lobby room, 1 kitchen, 1 changing room equipped with changing table, 1 staff break room, 1 program manager office and 3 restrooms for client and staff use. LPA observed adequate storage for clients and staff personal belongings. There is one parking lot, located at the West end of the building which is protected from Atlantic Avenue traffic, specifically designed for client pickup/drop-off and staff parking.
LPA observed 3 first-aid kits which are located throughout the facility, each with adequate supplies, and two (2) first-aid manual, along with centrally stored medication cabinet which is located in the kitchen area and is inaccessible to clients in care.
Physical Plant:
Facility is clean, sanitary, and in good repair. Protective devices are in place, which include floor mats and outlet covers as well as table corner covers. Indoor and outdoor passageways, open porches, and other areas of potential hazard are free of obstructions. All windows are stationary and are clean and in good repair. Facility temperature is comfortable, measured at 68.2 degrees F. Open porches, and areas of potential hazard are well-lit. Smoke alarms operate properly. Carbon monoxide detectors operate properly.


Report continues, see LIC809C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2024
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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: ACHIEVING RESULTS TOGETHER
FACILITY NUMBER: 198320484
VISIT DATE: 05/30/2024
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Records:
All records are kept digitally and LPA was sent a link, which includes all staff CPR/First Aid certificates among other files. Each room in the facility contains 1 facility sketch, 1 disaster plan (LIC610D), 1 fire drill assignment(s) list and 1 personal rights of Developmentally Disabled individuals, directed from Dept. of Developmental Services.
Bathrooms:
Water was measured at 113.2 degrees F. and all 3 bathrooms are complaint under title 22 regulations.
Kitchen:
LPA observed the kitchen which includes 1 commercially sized fridge, 2 microwaves, 1 dishwasher, 1 clothes washer and 1 clothes dryer. LPA did not observe any sharp or dangerous objects left available to clients in care. There are ample storage cabinets which are also inaccessible to clients in care for additional supplies related to daily activities.
Activities:
There is ample space to allow all activities to be conducted indoors and outdoors, as the 1 community/lobby room is designed as an additional classroom and the front porch is gated which allows clients to freely exit for future community activities.

During this pre-licensing inspection, LPA did not find any deficiencies needing correction. LPA conducted the Component III Orientation with Katie Prodanovich, Programs Manager and copy of this report was provided. A copy of the facility evaluation report will be available 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 their assigned CAU Analyst.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC809 (FAS) - (06/04)
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