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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601400
Report Date: 08/27/2024
Date Signed: 08/27/2024 03:21:51 PM

Document Has Been Signed on 08/27/2024 03:21 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/
DIRECTOR:		JASKA, SHERRYFACILITY TYPE:
775
ADDRESS:14028 & 14030 PIONEER BLVDTELEPHONE:
(562) 868-3444
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 15CENSUS: 12DATE:
08/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Rosa VillalpandoTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Nune Margaryan and Mayra Cota conducted an unannounced annual visit at the facility using the CARE tool. LPAs met with Program Supervisor Rosa Villalpando and explained the reason for the visit. The facility is licensed as an Adult Day Program to serve 15 non - ambulatory adults clients. There are 60 clients enrolled in the program and the program is allowed 15 clients to be housed inside of the building per session. There is a morning session 8/8:30-12/12:30pm and an afternoon session 12/12:30-4/4:30pm. This program has a staff to client ratio of 1:3. All clients in the day program receive case management services provided by Harbor Regional Center. At the time of visit there were 12 clients at the facility.
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, Musical room, Computer room, Art room, Fitness room, Resource / Library area, Staff/ Client Locker area, and fully equipped kitchen. LPAs toured the facility with Program Supervisor and the following was observed: The program site is clean, safe, sanitary and in good repair. All passageways are free from obstruction. 2 fire extinguishers observed at the facility and are fully charged. The bathrooms were observed to be clean and operational. The water temperature was tested in both bathrooms and measured at 107.1 degrees F, which is within the required 105-120 degrees F. There is no pool or large body of water at the premises. There are 2 First Aid kits at the facility and are fully stocked with all required items. Facility does not keep or administer medications. Food is not prepared at this program and clients are able to bring their own food. The kitchen area has a refrigerator where the clients can store their food. Sharps are kept locked in an office.

Continue 809C

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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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Document Has Been Signed on 08/27/2024 03:21 PM - It Cannot Be Edited


Created By: Nune Margaryan On 08/27/2024 at 02:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: COLE VOCATIONAL SERVICES NORWALK
FACILITY NUMBER: 198601400

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPAs observed "Lysol" All purpose cleaner under the kitchen sink cabinet unlocked and accessible to clients, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/27/2024
Plan of Correction
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"Lysol" All purpose cleaner locked immediately. Citation cleared at the time of visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Nune Margaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2024


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: 08/27/2024
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 LPAs observed "Lysol" All-purpose cleaner under the kitchen sink cabinet unlocked and accessible to clients. Fully functioning smoke /carbon monoxide detectors were tested and operational. The last fire drill was completed 08/01/24. LPA reviewed 3 client and 3 staff records. Client/staff files are current and in compliance.

Deficiency is being cited. See LIC 809D.
Exit interview was conducted with Program Supervisor Rosa Villalpando.

A copy of the report/appeal rights was issued.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
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