198601150-8-11-2022-11-AS-LMOA-CH7KSB-20220811080916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601150
Report Date: 08/10/2022
Date Signed: 08/11/2022 08:09:23 AM

Document Has Been Signed on 08/11/2022 08:09 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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SVS OLD TORRANCE INCLUSION CENTER		FACILITY NUMBER:	198601150
ADMINISTRATOR:	RODRIGUEZ, ANGELA PONCE		FACILITY TYPE:	775
ADDRESS:	1870 W. CARSON ST UNITS D, E&F		TELEPHONE:	(310) 212-5253
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY: 18		CENSUS: 18	DATE:	08/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	RACHEL RAMIREZ		TIME COMPLETED:	04:00 PM

NARRATIVE

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On 8/10/22, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA Montoya called the facility, spoke with Program Director Rachel Ramirez and conducted a risk assessment. Based on the assessment, the facility is clear of Covid-19 infection. Upon arrival at the facility, LPA met with Program Director Rachel Ramirez and explained the purpose of today’s visit.

The facility is licensed for eighteen (18) clients which six (6) may be non-ambulatory; prefers to serve intellectual and developmental disabilities adults age 18 and over. There are sixty-one (61) clients currently enrolled. Facility does not handle clients cash resources. The facility is a vendor of Harbor Regional Center and South Los Angles Regional Center.

LPA toured the facility with Program Director Rachel Ramirez. The facility consists of a reception area, two (2) administrative offices, leisure room, art room, clients changing room, computer room, fitness room, style room, staff break room, client/staff locker room, storage room, three (3) coed bathrooms, quiet room, electrical room and a kitchen.

The licensee is operating the day program within the conditions and limitations specified on the license, including the capacity limitation during this visit. No firearms or poisons were located on the premises at the time of visit. No pools, ponds, and any other bodies of water was observed during this visit. Disinfectants, cleaning solutions, and poisons were locked up in the storage room and not accessible to clients. Hot water temperature was measured between 105-120 degrees Fahrenheit in bathroom#1. Toilets and wash basins were maintained in a safe, sanitary, operating condition, with provisions for handicapped individuals. The facility was clean, safe, sanitary, and in good repair for the safety and well-being of clients, employees, and visitors at the time of visit. The facility has one functioning carbon monoxide detector that meets statutory requirements located in the reception area and properly working smoke detectors throughout the facility. Each client is accorded safe, healthful, and comfortable accommodations, furnishings and equipment to meet their needs. Snacks are provided daily.

Evaluation report continued in LIC 809C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SVS OLD TORRANCE INCLUSION CENTER	FACILITY NUMBER: 198601150
	VISIT DATE: 08/10/2022

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The kitchen was kept clean, free of litter, and rubbish. First Aid Kit had all the required items. The last inspection held by the fire department was on 07/6/2022.

During the visit, LPA observed the facility's infection control practices. LPA observed sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved Mitigation Plan Report on file with CCLD.

California Code of Regulations, Title 22, Division 6, and Chapter 1 are being cited on the attached LIC 9099D.

An exit interview was conducted and a copy of this report and appeal rights were provided to Program Director Rachel Ramirez.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/11/2022 08:09 AM - It Cannot Be Edited

Created By: Lourdes Montoya On 08/10/2022 at 03:03 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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SVS OLD TORRANCE INCLUSION CENTER	FACILITY NUMBER: 198601150
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80087(g)(1)

(9) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas of poisons, and firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above. LPA observed the electrical room has no lock and readily available to clients in care. LPA also observed two blenders with blades and extra blender blades readily accessible to clients in the kitchen cabinets. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/11/2022
	Plan of Correction
1 2 3 4	The administrator agreed to install a lock in the electrical room. The administrator will also install a lock in one of the kitchen cabinets and store the blenders and the blender blades. POC shall be submitted to CCLD via email to lourdes.montoya@dss.ca.gov by the POC due date, 8/11/22.

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.

SUPERVISOR'S NAME:

Eva M Alvarez

LICENSING EVALUATOR NAME:

Lourdes Montoya

LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

LIC809 (FAS) - (06/04)

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