<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600995
Report Date: 11/15/2022
Date Signed: 11/15/2022 03:20:16 PM

Document Has Been Signed on 11/15/2022 03:20 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: DATE:
11/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director- Angelica RealTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced Required 1 year inspection at the facility and met with Nurse Audra Cuckler-Zwahlen and explained the purpose for todays visit.

The Adult Day 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 and five ambulatory. The program operating hours are 8:00 AM - 4:00 PM.

LPA Calderon and Audra toured the physical plant. The physical plant consists of: reception area, 7 program rooms (including quiet room and can be used for isolation if needed), kitchen with locked chemicals, 2 bathrooms , and shaded area in front of the building. LPA Calderon tested kitchen water measured at 116.3 F. Bathroom #1, hot water measured at 114.3 F, bathroom #2 hot water measured at 117.3 F. During the visit the Infection Control Domain was used, the facility had Covid-19 posters at the front entrance, bathrooms, and throughout the facility. A pre screening area with PPE supplies was observed upon entry into the facility. LPA Calderon observed a locked cabinet for medication and PPE/Disinfectants in Supervisor's Office. The smoke detectors/carbon monoxide detector are operable. LPA observed 2 fire extinguishers (front area & back room). Easter Seals has Van's for field trips in the Easter Seals Carson Transportation Lot. Clients use other means of transportation for attending day program like: Reliable Transportation, Beehive Transportation and Round Trip Transportation. LPA Calderon reviewed 5 staff employee files.

There were no deficiencies cited. An exit interview was held with Director Angelica Real and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1