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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601414
Report Date: 06/17/2022
Date Signed: 06/17/2022 02:48:41 PM

Document Has Been Signed on 06/17/2022 02:48 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 DR #100
MONTERY PARK, CA 91754
FACILITY NAME:WORK & SERVICE COALITIONFACILITY NUMBER:
198601414
ADMINISTRATOR:REYNALDO AROFACILITY TYPE:
775
ADDRESS:4070 EL SEGUNDO BLVDTELEPHONE:
(310) 349-2057
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 45CENSUS: 40DATE:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Reynaldo AroTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Jey Cardenas conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. Upon arrival LPA Cardenas met with Reynaldo Aro and conducted a risk assessment, based on the assessment, the facility is clear of Covid-19 infection. The purpose of todays visit was explained. The Adult Day Program (ADP) is licensed to serve 45 Developmentally Disabled Adults. There are currently 40 ambulatory clients in the Adult day care program.

LPA and administrator toured the inside and outside grounds. ADP consists of two buildings, an outdoor patio, large courtyard, vegetable garden, and two storage sheds. Building #1 contains two staff offices, activity space equipped with multiple computers, small room being used as an isolation room, kitchen and two bathrooms. Building #2 contains a large activity room, two bathrooms and a storage area. Day program clients bring their own lunches; however, program has backup food if necessary.



Client bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly; the shower was free of mold/mildew. Hot water temperature measured in bathrooms used by clients; bathroom observed to be in title 22 compliance. Comfortable temperature was maintained in the facility.

LPA toured the kitchen area and observed working refrigerator, stove, water dispenser. No knives are kept in the facility and toxins were kept in a locked storage cabinet. ADP doesn’t handle medication. The First Aid kit was available and fully stocked. There are no security bars or weapons on the premises. all fixtures and appliances are working properly.

Outside grounds were toured, and no bodies of water were observed. Walkways around the home were clear of hazards, passageways are free of obstruction. Common areas were clean and clear of hazards.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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 DR #100
MONTERY PARK, CA 91754
FACILITY NAME: WORK & SERVICE COALITION
FACILITY NUMBER: 198601414
VISIT DATE: 06/17/2022
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Two (2)Fire extinguishers are available in the first building and one(1) fire extinguisher is available in the second building, all are charged and have been inspected on 04/11/2022. Dual/ interconnected smoke/carbon monoxide detectors were tested and operable during time of visit.


During the tour, LPA observed the facility’s infection control practices. LPA verified that the facility has an approved mitigation plan report. LPA was properly screened for Covid-19 symptoms, temperature was checked and documented. LPA observed a sanitizing station at the facility entrance; visitors log with Covid-19 screening and temperature log, PPE supplies are readily available to staff, and an additional 90 day supply of PPE was observed. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is the shaded backyard area near building#2. LPA observed all staff wear a face covering. LPA observed required postings throughout the facility. CCLD PINS were readily available to staff and clients. Adequate lighting provided, storage for clients personal belongings was observed.

No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report provided to Mr. Aro.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC809 (FAS) - (06/04)
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