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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600995
Report Date: 11/23/2021
Date Signed: 11/23/2021 10:33:04 PM

Document Has Been Signed on 11/23/2021 10:33 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA NORWALKFACILITY NUMBER:
198600995
ADMINISTRATOR:SANKA, DIANE FFACILITY TYPE:
775
ADDRESS:13901 S PIONEER BLVDTELEPHONE:
(562) 868-7410
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 30CENSUS: 30DATE:
11/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Martin Cisneros(ADS supervisor)TIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Nicol Wesley conducted announced Required 1 year inspection at the facility and met with Adult Day Supervisor Martin Cisneros and explained the purpose for todays visit. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections. The facility phone number is 562 868 7410. There are currently no clients attending program as they participate in daily virtual session.

The program is housed in a commercial area(shopping plaza) and is vendorized through the Harbor Regional Center and is licensed to serve 30 developmentally disabled adults, ages 18 and above, of which 25 can be non-ambulatory. The program operating hours are 8:00 AM - 4:00 PM. The program is Community based and the physical plant consists of: reception area, 7 program rooms(including quiet room), locker area, kitchen, 2 bathrooms(1 is designated for staff), and shaded areas in front of the building.

During the visit the Infection control domain was used and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, and throughout the facility. Hand sanitizing gel and masks were located at the entry of each room. A Pre screening area with PPE supplies was observed upon entry into the facility. The mitigation plan was approved on 04/27/2021. LPA Wesley observed a locked cabinet for medication(clients are currently completing virtual session and there is no medication). The smoke detectors/carbon monoxide detector are operable. LPA observed 2 fire extinguishers(kitchen, back area). The water temperature was tested and measured 117.4 degrees F. There were no deficiencies cited.
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
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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