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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601138
Report Date: 09/21/2023
Date Signed: 09/22/2023 08:12:15 AM

Document Has Been Signed on 09/22/2023 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:SOCIAL VOCATIONAL SERVICES NORWALK INCLUSION CENTEFACILITY NUMBER:
198601138
ADMINISTRATOR:MONICA VALENCIAFACILITY TYPE:
775
ADDRESS:11849 FIRESTONE BLVD.TELEPHONE:
(310) 944-3303
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 27CENSUS: 25DATE:
09/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Regional Director Leo VasquezTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced annual inspection visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with the Regional Director Leo Vasquez and the purpose of the visit was discussed.

Structure/Physical Plant: The program is housed in a commercial area, with its own parking lot and consists of a single story structure with a reception area, three offices, eight program breakout rooms, changing room, locker area for client personal storage, kitchen, staff break room/kitchen, washer/dryer room, two bathrooms and a shaded patio area. The program is equipped with air conditioning. There are no bodies of water or fireplaces. Shaded patio area is gated and safe from traffic. Accommodations: Adequate accommodations observed throughout facility. Hallway and Doorways: Free and clean of obstruction and debris. Bathrooms: All restrooms have a working toilet stalls, wash basins, and urinal for the male restroom. Emergency Phone Numbers, Exit Plan & Menu: Facility has a working phone landline. There is a cordless phone for client use if needed. Fire Extinguishers observed Food Service: All food and adequate utensils such as, dishes, cups, bowls and plates observed in the kitchen. Knives, cutlery and other sharps inaccessible to clients. Smoke Detectors & Fire Extinguishers: Detectors Electrical & connected. Battery operated & working, all detectors tested and operational. Fire extinguishers observed. Toxins: Locked/stored for staff use only. Hot Water Temperature: Measured within title 22 regulations all around. Medications, First-Aid Kit & Book: Medications centrally stored and inaccessible to clients and administered by LVN only. First aid kit observed. Postings: Required wall postings observed. Residents & Staff Files: LPA reviewed (6) records on file , as well as Five (5) Staff Files . Emergency Disaster Plan observed. Plan of Operations Observed. Infection Control plan observed

Inspection tool was completed and no deficiencies were observed. Exit interview was conducted, and a Facility Evaluation Report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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