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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600086
Report Date: 06/13/2023
Date Signed: 06/13/2023 02:15:44 PM

Document Has Been Signed on 06/13/2023 02:15 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:MARINE ATCFACILITY NUMBER:
198600086
ADMINISTRATOR:ERNESTINE BARNESFACILITY TYPE:
775
ADDRESS:426 E. 99TH STREETTELEPHONE:
(310) 330-8368
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY: 125CENSUS: 44DATE:
06/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Savelio NaomiTIME COMPLETED:
02:30 PM
NARRATIVE
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 On 06/13/23, Licensing Program Analyst (LPA) Antonine Richard made an unannounced Required- 1 Year visit to Marine ATC Adult Day Program. LPA met with Program Manager Savelio Naomi, and later joined with Operations Director, Fusi Austin and Mathews Charlene informed them the purpose of today's visit was to conduct an annual required visit using the new Care Inspection Tool. LPA will tour the physical plant, review staff and client’s records. The Day Program is vendored by Westside Regional Center (WRC). . There are 44 consumers in attendance at the time of this inspection.

LPA and staff toured the entire facility which included the following:
Lobby, reception/front office, administrative offices, conference room, classrooms, gym, changing rooms, main kitchen, dining room, recycling classroom, computer room, small kitchen, 17 restrooms, laundry room, staff lounge, storage rooms, basement, outdoor shaded area. There was a knife on the table of one of the administrator's offices, and clients have access to the office. There are no bodies of water or firearm/ammunition on the premises. Each room is adequately equipped and furnished. The day program has posted current activity schedules, and each instructor develops and follows specific monthly lesson plans. All fire extinguishers were fully charged. The last fire drill was conducted on 05/01/23. The hot water temperature measured 117.9F to 119.1F degrees.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MARINE ATC
FACILITY NUMBER: 198600086
VISIT DATE: 06/13/2023
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 LPA reviewed consumer files as well as staff files which were current and updated with required records. As part of the inspection LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to consumers and staff, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were observed. Logs are kept indicating the times when cleaning and sanitizing is completed. And LPA was screened for COVID-19 at the door, temperature was taken, and logged in the visitors log in book.

The Adult Day Program is in a commercial business building located in a residential neighborhood, operating hours are 8:00 A.M. to 4:30 P.M., clients are at the day program from 8:00 A.M. to 2:00 P.M.; 5 days a week Monday through Friday. All consumers bring their own lunch, if clients forget their lunch the day program will provide a snack. Clients are trained in preparing simple meals. They participate in stimulating activities inside the facility.



During today's visit there was a deficiency observed.

Exit interview held, plan of correction was developed. A copy of the report and appeals rights was provided to Operation Director Austin Fusi
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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Document Has Been Signed on 06/13/2023 02:15 PM - It Cannot Be Edited


Created By: Antonine Richard On 06/13/2023 at 01:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MARINE ATC
FACILITY NUMBER: 198600086

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, the licensee did not comply with the section cited above. LPA obseved There was a knife on the table of one of the administrator's offices, and clients have access to the office. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2023
Plan of Correction
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The administrator agreed to have the knife removed and stored were inaccessible to residents. Proof correction will be submitted via email to LPA, Antonine.Richard@dss.ca.gov. Phone# (323) 516-4092
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ulysses Coronel
LICENSING EVALUATOR NAME:Antonine Richard
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023


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