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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600259
Report Date: 04/12/2022
Date Signed: 04/12/2022 10:20:47 AM

Document Has Been Signed on 04/12/2022 10:20 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SOCIAL VOCATIONAL SERVICES, LB INCLUSION CTR.FACILITY NUMBER:
198600259
ADMINISTRATOR:SERAFIN AVILAFACILITY TYPE:
775
ADDRESS:530 EAST WARDLOW ROADTELEPHONE:
(562) 424-7322
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: 18CENSUS: 18DATE:
04/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:ADMINISTRATOR AMBER ZURNTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA Calderon was met by Administrator Amber Zurn and the purpose of today’s visit was explained. The facility is licensed to serve 18 adult clients.

There are currently 18 clients in care 9 clients come into the facility and 9 clients are seen virtual. The facility is a 2-story structure with 10 rooms and 2 bathrooms, 2 activity rooms, kitchen and work out room, 2 offices, 1 computer room.

LPA Calderon and staff toured the physical plant. There is no bodies of water or firearm/ammunition on the premises. All client rooms were checked. and are in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. All equipment, computers, work stations are well maintained and there is adequately PPE stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were not accessible to clients. Smoke detectors were had wires, but only 2 Carbon Monoxide was found in the facility. Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA Calderon was met by Administrator Amber Zurn and the purpose of today’s visit was explained. The facility is licensed to serve 18 adult clients.

There are currently 18 clients in care 9 clients come into the facility and 9 clients are seen virtual. The facility is a 2-story structure with 10 rooms and 2 bathrooms, 2 activity rooms, kitchen and work out room, 2 offices, 1 computer room.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2022
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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SOCIAL VOCATIONAL SERVICES, LB INCLUSION CTR.
FACILITY NUMBER: 198600259
VISIT DATE: 04/12/2022
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During the visit, LPA observed the facility infection control practices. LPA did observe screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff were wearing face coverings, an isolation room is confirmed for the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.



During today’s visit there was no deficiencies under California code of regulation title 22, division 6, chapter 8.

Exit interview held and a copy of the report was provided to the Administrator Amber Zurn by hand.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
LIC809 (FAS) - (06/04)
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