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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600236
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:23:30 PM

Document Has Been Signed on 09/19/2024 02:23 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA CERRITOSFACILITY NUMBER:
198600236
ADMINISTRATOR/
DIRECTOR:		REAL, ANGELICAFACILITY TYPE:
775
ADDRESS:11110 ARTESIA BLVD STE CTELEPHONE:
(562) 860-7270
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 35CENSUS: 48DATE:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Adrian Perez Program CoordinatorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced required annual inspection using the CARE tools. LPA met with Program coordinator Adrian Perez and explained the reason for the visit. This facility is licensed to serve a capacity of thirty-five (35) Developmentally Disabled Ambulatory Adults, of which two (2) may be non-Ambulatory. The facility is vendorized through Harbor Regional Center. A tour of the single-story building was conducted with Adrian Perez which included: reception area, 6 offices, file room, 2 restrooms, kitchen, 2 activity rooms, computer lab, and conference room.

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 clients. There are two fire extinguishers observed in the kitchen and in the copy room. Facility has a fire alarm system with a carbon monoxide detector throughout the facility. The restrooms were observed to be clean and have the required grab bars. The water temperature was tested and measured at 114.4 in bathroom #1, 105.6 *F in bathroom #2. 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 clients with extra clothing available for their use.

Four (4) staff files were reviewed and included LIC 501, CPR/training, and health screening with TB. Four (4) client files were reviewed and included physicians report, TB clearance, and IPP report. Last fire/earthquake drill was conducted in September 2024. Infectious control plan was reviewed.

No deficiency was observed during today’s visit. Exit interview was conducted and a copy of report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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