<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601273
Report Date: 11/10/2022
Date Signed: 11/10/2022 10:49:24 AM

Document Has Been Signed on 11/10/2022 10:49 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:EASTER SEALS SOUTHERN CALIFORNIA FACULTY HOMEFACILITY NUMBER:
198601273
ADMINISTRATOR:NJOROGE, PRISCILLAHFACILITY TYPE:
735
ADDRESS:11644 FACULTY DRTELEPHONE:
(562) 402-0252
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 3CENSUS: 2DATE:
11/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator: Kally Cardenas 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 11.10.22, Licensing Program Analyst (LPA) Ashley Calderon arrived at the facility to conduct an unannounced annual required inspection. Upon entry LPA met with DSP worker Danyell Newsome and discussed the purpose of todays visit.

Today's visit consisted of LPA Calderon at 9:30am met with Director Kimya Oliver and inspecting the facility physical plant. The facility is a single-story home with attached garage used for storage. During the inspection, LPA Calderon inspected the kitchen which had sufficient perishable and non-perishable food items, water temperature measured 116.9 F Degrees. Chemicals, sharp items and medication stored in kitchen area, that were inaccessible to clients and were locked. LPA Calderon inspected the bathrooms. LPA Calderon tested the hot water temperature in bathroom #1 measured at 112.3 Fahrenheit degrees and bathroom #2 was under construction and inaccessible to clients. LPA Calderon observed that the bathroom were clean and maintained in safe and sanitary operating conditions with equipment for handicapped individuals. LPA Calderon observed that the facility there are personal hygiene items such as soap, toilet paper, toothpaste, toothbrushes, emergency supply, and sufficient PPE. LPA Calderon observed that the facility has a supply of linen and towels. LPA Calderon inspected the medication storage and reviewed Medication Record Log. LPA Calderon observed that the client’s medication were labeled and stored in a locked cabinet which was accessible only with a key. LPA Calderon observed the back yard premises which does not have a swimming pool or bodies of water. LPA Calderon tested the smoke detectors and carbon monoxide detectors; observed that the detectors were operational. LPA Calderon inspected the clients’ bedrooms and observed that the bedrooms were clean, and the lights were operational. LPA Calderon, observed that the administrator certificate is current and expire Jan 2023.

LPA Calderon discussed with Kimya Oliver and Kally Cardenas association with Guardian.

Based on the observations made during this annual inspection, per Title 22 of the California Code of Regulations, no deficiencies were noted today, and no citations were issued. An exit interview was conducted with the facility administrator Kally Cardenas and a copy of this report was provided to Kally.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1