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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601400
Report Date: 10/11/2022
Date Signed: 10/11/2022 02:40:29 PM

Document Has Been Signed on 10/11/2022 02:40 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:COLE VOCATIONAL SERVICES NORWALKFACILITY NUMBER:
198601400
ADMINISTRATOR:JASKA, SHERRYFACILITY TYPE:
775
ADDRESS:14028 & 14030 PIONEER BLVDTELEPHONE:
(562) 868-3444
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 15CENSUS: 60DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:42 PM
MET WITH:Administrator Sherry JaskaTIME COMPLETED:
03:00 PM
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On 10/11/2022 at 12:42 p.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced visit for the purpose of conducting the required annual inspection. On today's visit LPA met with Administrator, Sherry Jaska who assisted with today’s visit. Administrator Sherry stated 60 clients are enrolled in the program at this time with 30 enrolled in the morning session 8/8:30-12/12:30pm and 30 enrolled in the afternoon session 12/12:30-4/4:30pm. This program has a staff to client ratio of 1:3. All clients in this program receive case management services provided by Harbor Regional Center.

The facility is licensed to serve 15 clients between the age of 18 and 59 years old, of which 15 shall be non-ambulatory. The facility is in a shopping strip mall/ business setting and consists of the following: Rest/Isolation Room, 3 administrative offices, 2 All Gender bathrooms, Game room/Recreation, Computer room, Art room, fitness room, Resource room, Staff/ Client Locker area, and fully equipped kitchen/ snack.

Report continued on 809c
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: COLE VOCATIONAL SERVICES NORWALK
FACILITY NUMBER: 198601400
VISIT DATE: 10/11/2022
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During the tour LPA observed, reviewed, and inspected 3 staff files. Fully functioning smoke /carbon monoxide detectors were tested and operational. Fully charged fire extinguishers and located throughout the facility. LPA observed locked area for toxins, sharp objects, and the facility is not currently assisting with medications. The facility passageways and doors are not blocked or obstructed. LPA did not observe any large bodies of water. Water temperature tested within normal limits between 111.8-114.0 degrees Fahrenheit. Bathrooms are single person use for all genders. LPA toured the kitchen and observed the pantry, cupboards, stoves, and refrigerator are clean. Refrigerator temperature met regulation, all dishes and utensils were clean, all walls and floors were in good repair. Buildings and grounds free from hazards. Last emergency drill was conducted on 9/22/22. LPA discussed infection control practices with facility Administrator.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided to Administrator Sherry Jaska.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
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