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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600995
Report Date: 07/24/2023
Date Signed: 07/25/2023 08:12:14 AM

Document Has Been Signed on 07/25/2023 08:12 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
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: 19DATE:
07/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Angelica Real and Brittany Medrano TIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced Required 1 year inspection at the Easter Seals Southern California Norwalk, and met with Director, Angelica Real. LPA Rea explained the purpose for today's visit and was assisted by Ms. Real and Ms. Brittany Medrano.

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 Rea toured the physical plant, which consists of of: reception area, 7 program rooms (including quiet room and can be used for isolation if needed), kitchen, with closet for locked chemicals, 2 bathrooms, and shaded area in front of the building, water temperature measured between 105* F and 120 * F as required. The Kitchen and restrooms, were clean and operable. A pre screening area with PPE supplies was observed upon entry into the facility. LPA Rea observed a locked cabinet for medication and sharps/knives in Supervisor's Office. The smoke detectors and carbon monoxide detector are operable. LPA observed 2 fire extinguishers (front area & back room). Director stated that clients use other means of transportation for attending day program. As a part of the inspection, reviewed four (3) client records, and (3) staff files, and conducted interviews with staff and clients. The last emergency drill was conducted on 6/28/23.

There were no deficiencies cited. An exit interview held and copy of report was provided to Ms. Real.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2023
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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