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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600661
Report Date: 12/19/2024
Date Signed: 12/19/2024 11:25:47 AM

Document Has Been Signed on 12/19/2024 11:25 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:OUR HOUSE THEATRICAL LIVING & LEARNING CENTERFACILITY NUMBER:
198600661
ADMINISTRATOR/
DIRECTOR:		SHAHWAN, BARBARAFACILITY TYPE:
775
ADDRESS:1123 E DOMINGUEZ ST. SUITE CTELEPHONE:
(310) 763-4998
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 80CENSUS: 45DATE:
12/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:17 AM
MET WITH:Gisela AcostaTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 12/19/24, at 9:17am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced visit to Our House Theatrical Living & Learning Center. The purpose of today’s visit was to conduct the required annual inspection, using the new Care Tool. LPA was met by Gisela Acosta, Program Director, and the purpose of today’s visit was explained. The facility is licensed to serve eighty (80) adults of which seventy-eight (78) may be non-ambulatory. The clients are South Central Los Angeles Regional Center clients. Currently, the facility has (38) ambulatories and seven (7) non-ambulatory clients. None of the clients have Restricted Health Care Conditions and none utilizes postural supports or protective devices. The facilities’ annual fees are current.

The facility is a single-story structure located in a commercial building. The facility is one large building consisting of the following: Parking lot (drop off/pick up area), one (1) kitchen, one (1) large activity room, three (3) changing/isolation rooms, one (1) waiting room/office, three (3) consumer restrooms, two (2) staff restrooms, conference room and offices.

The department conducted a records review of (4) client records, (5) staff records, and reviewed the facility disaster plan. The facility does not handle cash resources for clients. All client & staff records were complete. The facility disaster plan was current and in compliance with Title 22 regulations at the time of visit. The department reviewed (2) Client Medication Administration Records and did not observe any discrepancies at the time of visit.

At 9:30am, LPA and the Program Director toured the facility. The department observed the facility to be clean, sanitary, and in good repair. The department tested the smoke/carbon monoxide detectors, and they were operable. The department observed that the facility has (5) fire extinguishers that were fully charged and last serviced on 06/10/2024. Toxins and sharp objects were locked and inaccessible to consumers. The last fire/emergency drill was conducted on 10/27/2024.

Facility Evaluation Report Continued on LIC 809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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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: OUR HOUSE THEATRICAL LIVING & LEARNING CENTER
FACILITY NUMBER: 198600661
VISIT DATE: 12/19/2024
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The restrooms were clean and operable. The water temperature was tested and measured at 105.8 degrees F. The kitchen and all offices and conference rooms were clean. The refrigerators were all sanitary and in working condition for consumers use. Food items in the refrigerator and food storage are properly stored. The day program does not provide lunch however snacks are available to consumers. First aid kit and manuals are available. Walkways throughout the day program are clear of hazards and all exits are clear of debris. The facility had all the mandated posters. The facility has current liability insurance, and it expires on 07/22/2025.

During the visit, the department observed the facility infection control practices. The department observed screening protocols for visitors, staff, and clients. The department observed that sanitizing stations were in common areas and restrooms. The department observed that the facility had the required postings, posted throughout the facility. The department further observed the facility to have a 90-day supply of Personal Protective Equipment (PPE).

The department advised the Program Director to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues.

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

An exit interview was held, and a copy of the Facility Evaluation Report was provided to Gisela Acosta, Program Director.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC809 (FAS) - (06/04)
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