198600995-7-14-2026-28-AS-EMAT-DVYQVL-20260714123030

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600995
Report Date: 07/14/2026
Date Signed: 07/14/2026 12:30:50 PM

Document Has Been Signed on 07/14/2026 12:30 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	EASTER SEALS SOUTHERN CALIFORNIA NORWALK		FACILITY NUMBER:	198600995
ADMINISTRATOR/ DIRECTOR:	SANKA, DIANE F		FACILITY TYPE:	775
ADDRESS:	13901 S PIONEER BLVD		TELEPHONE:	(562) 868-7410
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY: 30		CENSUS: 28	DATE:	07/14/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:09 AM
MET WITH:	Program Director- Angelica Real		TIME VISIT/ INSPECTION COMPLETED:	12:30 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) Elena Mallett conducted an unannounced visit to the facility for the Annual Inspection. LPA met with Program Director Angelica Real and the purpose for the visit was explained. The facility is licensed to serve 30 developmentally disabled adults age 18 and over of which 25 may be non-ambulatory. This is a single- story facility located in Norwalk, CA. A tour of the facility includes: Dining room, living room, two workrooms, one conference room, computer lab, refreshing room, kitchen, storage room ,one Private Restroom, one Restroom with stalls and two sinks. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has sufficient PPE supplies and maintain the required Infection Control Plan. Staff are disinfecting reguarlay and practicing hand hygiene. Physical Plant & Environment Safety: The facility is clean and sanitary. The facility hallways and walkways were clear and free of obstruction and debris. Smoke detectors were observed and operable. A carbon monoxide detector was not present. A deficiency was cited. See 809-D. There was a fully charged fire extinguisher present. No bodies of water were observed at the facility. The hot water temperature was tested throughout the facility restrooms and measured within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, poisons and hazardous items are stored in a secured/locked storage closet and inaccessible to clients. Clients are provided with a water container that is readily available. There is a closet for clients to store their belongings. There was no outdoor activity area. Clients participate in activities in the community such as volunteering at Good will and a local church and going to shops and movies in the area. There are table top games, computers ,exercise and music videos for clients to use at the center. Clients utilize the kitchen for cooking activities

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026

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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA NORWALK	FACILITY NUMBER: 198600995
	VISIT DATE: 07/14/2026

NARRATIVE

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Operational Requirements: The facility has the appropriate fire clearance. Staff are knowledgeable on their reporting requirements.
Staffing: There is sufficient staffing at all times in the facility. Activity groups contain three or four individuals.
Personnel Records-Training: LPA reviewed 5 staff files, each file was reviewed for criminal record clearance, current First Aid/CPR and sufficient on-going training. Program Director Angelica Real has proper training and experience to meet the requirements.
Client Records-Incident Reports: Client files are kept in a secure location within the staff office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Consent Forms, and Appraisal Needs & Services Plan. LPA reviewed 5 client records without any issues.
Client Rights-Information: Client Rights Posters was observed.
Food Service: Pesticides and other similar toxic substances are not stored near food/kitchen areas. Clients bring lunch and the lunches are stored in either the refrigerator in the kitchen area or in a cabinet. Lunch is not provided by program but clients participate in baking activities frequently that utilize the kitchen. Operable appliances were observed. Food is kept separate from toxins, cleaners and poisons. Knives and sharps are inaccessible to clients.
Health Related Services: Staff responsible for providing direct care and supervision maintain training in First-Aid/CPR. There are 2 clients that require assistance with medication, LPA reviewed the two medication logs and there was no issues. Medications are properly stored in a locked cabinet and inaccessible to clients. Incidental Medical & Dental: Staff have proper training documented within the personnel files.
Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and relocation sites and designation of staff responsibilities and utility shut off points identified. An emergency kit with flashlights, food and water was observed. A fully stocked first aid kit and manual were present. Facility conducts monthly disaster drills with the last drill having been conducted on on 06/09/26.
Emergency Intervention: Clients at this facility have not needed the use of restraints or the use de-escalation techniques.

Per Title 22 regulations there was a deficiency cited today. An exit interview was conducted with Program Director Angelica Real and a copy of this Licensing Report was provided along with Appeal rights.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/14/2026 12:30 PM - It Cannot Be Edited

Created By: Elena Mallett On 07/14/2026 at 12:11 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA NORWALK	FACILITY NUMBER: 198600995
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1503.2

General Provisions

Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that there was no carbon monoxide detector present at the facility which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/15/2026
	Plan of Correction
1 2 3 4	By POC date, Program Director will fax LPA proof of purchase and installation of carbon monxide detector for the facility. During LPA's visit POC was cleared. Staff purchased and installed a carbon monoxide detector and it was observed to be operable.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Fernando Fierros
NAME OF LICENSING PROGRAM MANAGER:

	Elena Mallett
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/14/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026

LIC809 (FAS) - (06/04)

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