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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600236
Report Date: 09/19/2023
Date Signed: 09/19/2023 02:11:17 PM

Document Has Been Signed on 09/19/2023 02:11 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA CERRITOSFACILITY NUMBER:
198600236
ADMINISTRATOR:REAL, ANGELICAFACILITY TYPE:
775
ADDRESS:11110 ARTESIA BLVD STE CTELEPHONE:
(562) 860-7270
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 35CENSUS: 32DATE:
09/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Angelica RealTIME COMPLETED:
02:30 PM
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On 9/19/2023 at 9:00 a.m., Licensing Program Analyst’s (LPAs) Jewel Baptiste and Nicol Wesley made an unannounced visit to the facility for the purpose of conducting a required annual inspection. LPAs met with Supervisor ADS, Victoria Panuco, and explained the purpose for the visit. Executive Director Angelica Real arrived at 9:30 and assisted with the visit. The facility is an Adult Day Program (ADP) licensed to serve 35 adults ages 18 and over and approved for two non-ambulatory clients. The facility is vendorized through Harbor Regional Center. The last emergency disaster/fire drill was conducted on 8/25/23. During today's visit LPAs inspected the physical plant, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (3) staff files, (5) client files, and interviewed (2) staff and (5) clients.


The program consists of 1 large single-story building. A tour of the single-story building was conducted with Angelica Real which included: reception area, 6 offices, file room, 2 restrooms, kitchen, 2 activity rooms, computer lab, and conference room. During the tour, the following was observed: a total of 32 clients were at the facility during the visit. The staff to consumer ratio is 3:1. The program site is clean, safe, sanitary and in good repair. All passageways are free from obstruction. Disinfectants, cleaning solutions and poisons are locked in a janitorial closet and inaccessible to consumers. There are two fire extinguishers were observed in the kitchen and in the copy room. They both had recent inspections and were fully charged. There were (2) smoke alarms were tested and observed to be operational, and the carbon monoxide detector was also tested and operational. The restrooms were observed to be clean and have the required grab bars. The water temperature was tested and measured at 116.0*F in bathroom#1, 111.0*F in bathroom#2 and 116.2 F in the Kitchen. The program maintains a comfortable temperature in each room/office. The First Aid kit is kept in the kitchen and is fully stocked with all required items including a current First Aid manual. Facility does not store or administer medications. Food is not prepared at this program and clients are able to bring their own food. The kitchen area has a refrigerator where the clients can store their food and is in good repair. Sharps are kept locked and inaccessible in a hallway closet. There are lockers for consumers with extra clothing available for their use- all separated and labeled for each consumer.

(Report Continued on LIC809-C...)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA CERRITOS
FACILITY NUMBER: 198600236
VISIT DATE: 09/19/2023
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LPA reviewed 5 consumer files to confirm emergency contact is updated and consumers have health screenings on file. LPA reviewed 2 staff records to confirm health screenings, training, and fingerprint clearances.

Facility was observed to have 30 days supplies of Personal Protective Equipment (PPE), and some available at the entrance, readily available for consumers, staff, and visitors. Facility is following COVID-19 recommendations regarding screening all individuals at entry. COVID-19 signage was observed throughout the facility and hand-washing signs were observed in the bathrooms. Sufficient hand soap, hand sanitizer, and paper towels were observed for hand washing.

An exit interview was conducted with Executive Director Angelica Real and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
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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