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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601302
Report Date: 03/11/2022
Date Signed: 03/11/2022 01:15:53 PM

Document Has Been Signed on 03/11/2022 01:15 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:C-H ADULT DAY CENTER PROGRAMFACILITY NUMBER:
198601302
ADMINISTRATOR:BROWN, MARIETTAFACILITY TYPE:
775
ADDRESS:8026 E ALONDRA BLVDTELEPHONE:
(562) 630-8123
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY: 70CENSUS: 15DATE:
03/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Maxine Hartwell (Licensee)TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Kruz Long conducted an unannounced visit to the facility for the purpose of an Annual Inspection. Upon arrival, LPA met with Maxine Hartwell (Licensee) and explained the purpose of the visit.

A tour of the facility includes: Reception area, 2 activity rooms, 3 restrooms (1 men, 1 women, 1 shared), kitchen, staff kitchen, locker room, 3 storage rooms, 4 offices and 1 conference room.

During today's visit, LPA observed the following: A licensee is not operating a day program beyond the conditions and limitations specified on the license, including the capacity limitation. Motor vehicles used to transport clients is maintained in a safe operating condition. All clients are protected against hazards. There are no pools and bodies of water. Disinfectants, cleaning solutions, poisons is inaccessible to clients.
Hot water temperature measured at 105 degrees F in the shared restroom. Smoke detectors and carbon monoxide detector is operational. Fire extinguishers throughout the facility is fully charged. All toilets, hand washing facilities is safe, sanitary and in operating condition. First aid kit is fully stocked including the first aid manual. The licensee provides care and supervision necessary to meet the client's needs and all services specified in the admission agreement. Client is kept clean, dry and the day program is free of odors. Program personnel is sufficient in numbers and competent to provide the services necessary to meet individual client needs. The Individual Program Plan is maintained in the client's file. All individuals subject to a criminal record review has obtained a clearance. Disaster drills was conducted within the last 6 months. Staff responsible for direct care and supervision have current First Aid and CPR. The administrator is at the program site the number of hours necessary to manage and administer the program.

No deficiencies were observed during today's visit.

An exit interview was conducted and a copy of this report was provided to Maxine Hartwell.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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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