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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600863
Report Date: 11/14/2022
Date Signed: 11/14/2022 12:05:22 PM

Document Has Been Signed on 11/14/2022 12:05 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA CARSONFACILITY NUMBER:
198600863
ADMINISTRATOR:CAREYNAVARRETE, AMBERFACILITY TYPE:
775
ADDRESS:1740 W CARSON STTELEPHONE:
(310) 328-6974
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 18CENSUS: 18DATE:
11/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Angela Quaglia Program DirectorTIME COMPLETED:
12:22 PM
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Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced Annual inspection visit and infection
control inspection to the above facility. LPA was met by Angela Quaglia, Program Director and the purpose of today’s visit was explained.

There are currently (34) Harbor Regional Centers consumers in placement, 17 ambulatory 17 non-ambulatory. The Day Program has 17 clients physically at the facility. Facility alternates in-person clients. The facility is a commercial one-story structure located in a commercial district. The facility consists of the following: administrators office, conference/quite room, storage closet (toxins-first aid), 2 restrooms, kitchen, main activity room with divider, covered middle patio with chairs and tables.

LPA and Administrator toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. The (2) bathrooms are clean and operational. 1 client file was current, and 1 staff was current. Smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are kept in the facility in a locked cabinet. Facility does not provide food for client’s; clients bring their own lunch however supplies snack if necessary. A comfortable temperature is maintained in the facility. Water temperature is between 115.3 and 118.7 degrees. linens are adequate, hazardous toxins and/or items are inaccessible to clients, 4 fire extinguishers are fully charged.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2022
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA CARSON
FACILITY NUMBER: 198600863
VISIT DATE: 11/14/2022
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CONTINUED

Exit, walkways and/or passageways, are free of debris and/or hazards. The facility is in good repair.

During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in locked closet. LPA observed staff wearing masks, conference/quite room will be converted to isolation room (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing not completed for staff, there are required postings throughout the facility. Visitor designated area, facility has internet & IPAD for clients to use, client’s temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 60 days. All staff are vaccinated and boosted with the exception of two on an exemption. A technical advisory was issues for N95 fit testing.

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

An exit interview conducted with Angela Quaglia, Program Director and copy of report provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC809 (FAS) - (06/04)
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