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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601150
Report Date: 10/26/2023
Date Signed: 10/26/2023 02:57:37 PM

Document Has Been Signed on 10/26/2023 02:57 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SVS OLD TORRANCE INCLUSION CENTERFACILITY NUMBER:
198601150
ADMINISTRATOR:RODRIGUEZ, ANGELA PONCEFACILITY TYPE:
775
ADDRESS:1870 W. CARSON ST UNITS D, E&FTELEPHONE:
(310) 212-5253
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 18CENSUS: 13DATE:
10/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:22 AM
MET WITH:Jackline SandovalTIME COMPLETED:
03:00 PM
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On 10/26/23 8:22AM , Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced annual required visit, met with Administrator Jackline Sandoval 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 were 13 clients in care and 15 staff members. 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 Administrator. 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 at 109.5 degrees Fahrenheit in one of the restrooms. 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.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SVS OLD TORRANCE INCLUSION CENTER
FACILITY NUMBER: 198601150
VISIT DATE: 10/26/2023
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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 07/03/2023.

Five client and five staff files were review. One client (locked and inaccessible) medication was reviewed. Three clients and three staff members were interviewed.

An exit interview was conducted and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
LIC809 (FAS) - (06/04)
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