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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601231
Report Date: 06/26/2023
Date Signed: 06/26/2023 12:18:20 PM

Document Has Been Signed on 06/26/2023 12:18 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:PASW IIFACILITY NUMBER:
198601231
ADMINISTRATOR:JOHN THOMAS PAIZISFACILITY TYPE:
775
ADDRESS:231 E. SPRUCE AVE.TELEPHONE:
(310) 674-1346
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY: 30CENSUS: 12DATE:
06/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:CHARDELL BROWNTIME COMPLETED:
12:30 PM
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On 6/26/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual required visit using the new Care Inspection Tool. LPA met with Administrator Chardell Brown and explain the purpose of today’s visit.
The facility is a one-story structure located in a commercial building. Facility grounds consists of: talent manager's office, staff office, consumer support office, dance studio, client's locker area, clients break room, two restrooms, wardrobe costume/storage room, multipurpose room, gated parking lot and a shared patio with shaded area.

LPA and day administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected and had adequate lighting furnishings. Bathrooms were found to be within Title 22 regulations and were clean and operational. A comfortable temperature of 74 degrees was maintained. The hot water temperature tested at 105.3F degrees.

LPA observed the day program to be sanitary and appropriately supplied at the time of visit. Storage room for cleaning supplies, toxins, and sharps objects were stored and not accessible to consumers. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable.

During this visit, LPA observed the day program's infection control practices. LPA observed screening protocols for visitors, staff, and consumers, sanitizing stations in common areas and restrooms. LPA observed staff and consumers were wearing face coverings, LPA observed the facility had a sufficient supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. Facility files were reviewed.

No deficiencies were cited during this inspection visit.
An exit interview was conducted and a copy of this report was provided to administrator Chardell Brown.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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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