198601233-10-27-2023-11-AS-RCLD-CWZNVE-20231027104748

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601233
Report Date: 10/27/2023
Date Signed: 10/27/2023 10:48:04 AM

Document Has Been Signed on 10/27/2023 10:48 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SOCIAL VOC.SERVICES-REDONDO BEACH INCLUSION CENTER		FACILITY NUMBER:	198601233
ADMINISTRATOR:	ANGELA P. RODRIGUEZ		FACILITY TYPE:	775
ADDRESS:	2772 ARTESIA BLVD		TELEPHONE:	(310) 793-9600
CITY:	REDONDO BEACH	STATE: CA	ZIP CODE:	90278
CAPACITY: 18		CENSUS: 16	DATE:	10/27/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Bianca Pina		TIME COMPLETED:	11:00 AM

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	On 10/27/23 at 8:15am, Licensing Program Analyst (LPA) Regina Cloyd made an unannounced case management visit to obtain additional information regarding an a client-on-client incident reported on a suspected dependent adult abuse form (SOC341) at this facility. LPA was greeted by Case Manager Argeli Lopez. LPA explained the purpose of the visit, reviewed files, and interviewed staff and client. At 8:20am, LPA reviewed the facility’s schedule for 10/16/23. The document reports that clients involved in the SOC341 were loaded in a white van to attend Billiards during the PM schedule. Two staff members (S#1 and S#2) and six clients were on board. At 8:27am, LPA reviewed the Personnel Report (LIC 500) dated for 10/13/23. S#1 and S#2 were listed on the report. At 8:33am, LPA interviewed Program Director Bianca Pina concerning the incident reported. Program Director recalled the incident and explained that C#1 does have behavioral episodes. During transports, C#1 likes to sit by staff and may have been triggered when C#1 was unable to sit next to staff. Program Director stated that the staff-to-client ratio is 1:3. At 8:40am, LPA reviewed client record. C#1’s current SVS Individual Needs and Service Plans addresses the client’s behavioral goals, plans, and progress. At 9:05am, LPA interviewed S#1 who recalled the incident reported on the SOC 341. On the way to play billiards, S#1 sat between C#1 and another client with behaviors. During the outing, C#1 mentioned that C#1 wanted to go home but staff informed C#1 that they would be going to the park next. On the drive to the park, C#1 sat next to another client, got mad, and hit the window, seat, and C#2. .

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

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: SOCIAL VOC.SERVICES-REDONDO BEACH INCLUSION CENTER	FACILITY NUMBER: 198601233
	VISIT DATE: 10/27/2023

NARRATIVE

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S#1 separated the two clients, checked on and provided an ice pack to C#2 (no visible bruising), and sat next to C#1. S#1 spoke with C#1 and reminded C#1 not to hit others. C#1 apologized and took multiple deep breaths as instructed.

At 9:25am, LPA interviewed S#2. S#2 stated that C#1 was the first to load the into the van, went to the back seat, and sat near the window. Then C#2 entered and sat next to C#1. C#1 immediately got mad and hit the window, seat, and C#2. Staff immediately separated C#1 and C#2. Staff sat next to C#1, reminded C#1 not to hit, and encouraged C#1 to apologize to C#2. Staff checked on C#2 and provided an ice pack. C#1 was calm once staff sat next to C#1.

At 9:30am, LPA reviewed S#1 and S#2 staff files and training records. On 07/10/23, both S#1 and S#2 attended an one hour “Mandatory In-Service: Behavior Support” training facilitated by the Program Director.

At 9:50am, LPA interviewed C#2 regarding the incident reported. C#2 recalled the details listed on the report. C#2 stated that C#1 got jealous because C#2 was sitting by staff. C#2 described how staff intervened and provided an ice pack.

C#1 did not attend the day program and was unavailable to interview.

Based on record review and interviews, LPA determine that there are no violations according to the California Code of Regulations, Title 22. No deficiencies cited, exit interview conducted.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC809 (FAS) - (06/04)

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