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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600404
Report Date: 04/30/2024
Date Signed: 04/30/2024 11:08:28 AM

Document Has Been Signed on 04/30/2024 11:08 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA SAN PEDROFACILITY NUMBER:
198600404
ADMINISTRATOR/
DIRECTOR:		PRESCOTT, DEEFACILITY TYPE:
775
ADDRESS:1453 W 8TH ST STE ATELEPHONE:
(310) 831-5902
CITY:SAN PEDROSTATE: CAZIP CODE:
90732
CAPACITY: 25CENSUS: 41DATE:
04/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Emily Lopez/Program SupervisorTIME VISIT/
INSPECTION COMPLETED:
11:08 AM
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On 4/30/2024, Licensing Program Analysts (LPA)Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Emily Lopez/Program Supervisor. The facility profile shows that the facility is licensed for a capacity of (25) clients ambulatory only. The program supervisor stated that the facility has (41) clients enrolled in the program. The staff-to-client ratio is: (3) to (1). Program Supervisor stated that the facility has (0) clients with a Restricted Health Care condition. Currently, there are (0) clients using protective or assisted devices. Clients are from: Harbor Regional Center and North Los Angeles Regional Center.

The day program is a single-story structure located in a small business plaza. The facility consists of an administrative office, cubicles, lobby area, arts, and crafts, living room with a television, computer lab, meeting area, kitchen, dining/work area, conference area, lockers/storage area, storage room, and two (2) coed bathrooms.

As a part of today's inspection, LPA reviewed (4) client records, (4) staff records, and medications and inspected the entire facility inside and out. All records were maintained properly.

LPA and Program Supervisor toured the entire facility, inside areas are free of hazards and obstructions. (2) restrooms have working toilets and wash basins. They will accommodate non-ambulatory clients in a wheelchair. Emergency Phone Numbers are Posted & readily available for review in the activity area. Fire Extinguishers are up to fire code. The facilities telephone system is working correctly.

Evaluation Report continues LIC 809-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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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: EASTER SEALS SOUTHERN CALIFORNIA SAN PEDRO
FACILITY NUMBER: 198600404
VISIT DATE: 04/30/2024
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Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature properly measures between 105F° and 120F°: bathroom #1 was 108.2F°, bathroom, #2 was 107.3°F and kitchen sink was 113.5F°. A comfortable temperature is maintained in the facility. Smoke detectors and carbon monoxide alarm system is build-in and checked by the fire department every year. The facility is equipped with central air. All knifes and poisons were kept locked at the time of visit.

A first aid kit has been inspected, with at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual, which are stored in locked steel drawers, available for staff use but inaccessible to clients. The facility conducted a fire drill on 3/28/24, and a Disaster Plan was on file. The program does not provide transportation.

The facility does not handle the cash resources of clients or manage clients’ medications. Facility is current with their annual fees.

LPA advise Program Supervisor that there should be no more than (25) clients at the same time inside the building since the fire clearance capacity is for only (25). During this visit LPA Iniguez observed less than 25 clients in the morning, then they proceeded to go out in the community, just (2) clients and (2) staff stay behind.


According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Emily Lopez/Program Supervisor.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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