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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600995
Report Date: 07/09/2024
Date Signed: 07/10/2024 08:57:54 AM

Document Has Been Signed on 07/10/2024 08:57 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA NORWALKFACILITY NUMBER:
198600995
ADMINISTRATOR/
DIRECTOR:		SANKA, DIANE FFACILITY TYPE:
775
ADDRESS:13901 S PIONEER BLVDTELEPHONE:
(562) 868-7410
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 30CENSUS: 29DATE:
07/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:01 AM
MET WITH:Martin Cisneros, SupervisorTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) S Vaid conducted an unannounced Required 1 year inspection at the Easter Seals Southern California Norwalk facility and met with Nurse Audra Cuckler-Zwahlen, Supervisor Martin Cisneros and explained the purpose for todays visit. Director Angelica Real arrived shortly after.

The Adult Day Program is located and operates 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 is operating between the hours of 8:00 AM - 4:00 PM.

LPA Vaid and Cisneros toured the physical plant. The facilities physical plant consists of: reception area, 7 program rooms (including quiet room that can be used for isolation if needed), kitchen has locked storage for toxins, 2 washrooms, and shaded area in front of the building. LPA Vaid tested kitchen water measured at 108.9 F. Bathroom #1, sink #1 hot water measured at 107.9 and sink #2 hot water measured at 112.4 F, bathroom #2 hot water measured at 117.3 F. The kitchen and restrooms, were clean and operable. A pre screening area with PPE supplies was observed upon entry into the facility. LPA Vaid observed a locked cabinet for PRN medication in the Supervisor's office. The smoke detectors and carbon monoxide detector are located throughout the facility and are operable. LPA observed 2 fire extinguishers (front area & back room), tested on 03/2024. Supervisor stated that clients use other means of transportation for attending day program. Easter Seals operates vans for field trips and also utilizes public transit. Clients use other means of transportation for attending day program like: Reliable Transportation, Beehive Transportation.

As a part of the inspection, reviewed two (2) client records, and (4) staff files, interviewed three (3) staff. The last emergency drill was conducted on 06/27/2024.

There were no deficiencies cited. An exit interview held and copy of report was provided to Martin Cisneros.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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