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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600863
Report Date: 08/08/2025
Date Signed: 08/08/2025 12:39:03 PM

Document Has Been Signed on 08/08/2025 12:39 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA CARSONFACILITY NUMBER:
198600863
ADMINISTRATOR/
DIRECTOR:		CAREYNAVARRETE, AMBERFACILITY TYPE:
775
ADDRESS:1740 W CARSON STTELEPHONE:
(310) 328-6974
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 18CENSUS: 17DATE:
08/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:47 AM
MET WITH:Ellamay Cruz-SchultzTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 08/08/25, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit to the facility listed above. LPA met with Program Director, Ellamay Cruz Schultz, and the purpose of today’s visit was explained. The facility is licensed to serve 18 developmentally disabled clients ages 18 and over and approved for 13 non-ambulatory clients. There are currently twenty-five (25) Regional Center clients in placement, ten (10) non-ambulatory, and fifteen (15) ambulatory.
Physical Plant/Structure The facility is a single-story commercial building located in a commercial district. The facility consists of the following: a front lounge area, office area, computer area, game room, music/media room, kitchen area, art room, refreshing room, two (2) restrooms, and two storage room. In the back LPA observed a shaded area with chairs and a table. LPA did not observe any bodies of water on the premises. All walkways inside and outside of the facility were observed clean, clear, and free of obstructions, debris, and hazards.
Rooms The front lounge area has a large table and chairs for clients to work at. Additionally, there are two (2) couches and a recliner for clients to use and relax. The computer area has four (4) tables with four (4) computers for clients to use. There art room has a table and chairs for clients to work at and cabinets with arts, crafts, and activities. The kitchen area was observed clean and sanitary. All appliances were observed operational and in good repair. LPA observed food to be labeled, dated, packaged, and stored properly. The facility does not provide snacks or meals to clients, they are available if a client forgets their lunch. The water temperature measured 113.2-degrees Fahrenheit. All knives and sharps are secured in a locked cabinet in a locked storage room. LPA observed three (3) large tables. The game room has a table, chairs, and a couch. LPA observed a variety of games available. The music/media room has a table, chairs, and a couch for clients use. LPA observed instruments and other activities available for clients. The
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA CARSON
FACILITY NUMBER: 198600863
VISIT DATE: 08/08/2025
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refreshing room has a large changing table and a cabinet with supplies for staff. The restrooms were observed to be clean and operational. The safety handrails are secured. The water temperature measured 106.4-degrees and 113.3-degrees Fahrenheit. The facility was kept at a comfortable temperature. All rooms were observed to have ample lighting. The facility was observed to be properly furnished and in good repair. File Review LPA reviewed the files for six (6) Clients and found they contained the required documents. LPA reviewed the files for the Program Director, and three (3) staff files and found they contained the required documents, training, and certification. LPA reviewed Staff’s CPI cards and observed them to be current. LPA reviewed training logs and logs for in-services that are conducted monthly. LPA observed required posting, posted throughout the facility.
Medications LPA observed Centrally Stored Medications secured in a locked cabinet in the Program Coordinators Office and are inaccessible to Clients. LPA observed medications in their original packaging. Medications are PRN medications and are only dispensed when needed.
Safety LPA observed smoke detectors and carbon monoxide detectors are operational. LPA observed four (4) fully charged fire extinguishers, lasted serviced on 02/05/25. The last inspection from the Torrance Fire Department was conducted on 01/06/25. LPA observed the Emergency Disaster Plan posted in every room of the facility and was last updated on 01/27/2025. The last Emergency Drill was conducted on 07/11/2025. The facility has a working landline telephone. LPA inspected the First Aid Kit and observed it had the required items and a current manual. No firearms or ammunition are stored at the facility.
Infection Control Upon entry, LPA observed a sanitizing station that had a visitor log, hand sanitizer and masks available. LPA observed a 30-day supply of Personal Protective Equipment (PPE) secured in a storage room. LPA observed all cleaning supplies secured in a cabinet in a locked storage room. LPA observed an ample supply of paper towels, and hand soap in the storage room. All trash cans were observed with tight fitting lids. LPA observed required Infection Control signs posted throughout the facility.

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 Program Director, Ellamay Cruz-Schultz, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC809 (FAS) - (06/04)
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