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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601414
Report Date: 04/28/2023
Date Signed: 04/28/2023 02:48:53 PM

Document Has Been Signed on 04/28/2023 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY 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: 30DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Emyflair DojilloTIME COMPLETED:
03:00 PM
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 04/28/23, Licensing Program Analyst (LPA), Wendy Gibbs conducted an unannounced annual visit using the full CAREs tool. Upon arrival LPA conducted a risk assessment to assure the facility if clear of Covid-19. LPA met with Job Coach, Elizabeth Perry and explained the purpose of today’s visit. We were later joined by Program Director, Emyflair Dojillo. The Adult Day Program is licensed to serve 45 Developmentally Disabled Adults. At the time of visit there were 30 clients present.
Structure The facility consists of two buildings. Building #1 contains two staff offices, activity room, isolation room, kitchen and two bathrooms. Building #2 contains a large activity room, two bathrooms and a storage area.
Physical Plant LPA Gibbs and Job Coach Perry toured the inside and outside of the facility. Outside there are 3 shaded areas with large rectangular tables and chairs. Two of the shaded area are for activities to be done outside. The third shaded seating area is the designated smoking area. In part of the outdoor activity area there is a basketball hoop and net set up for volleyball or other games. There is a vegetable garden that is maintained by clients with the assistance of staff. Next to the garden are two sheds. One shed contains the facilities files and the second is where gardening tools, and supplies are stored. LPA observed all walkways to be clean, clear, and free of obstructions and hazards. LPA did not observe any bodies of water.
Common Rooms LPA toured all common rooms. In building #1 the isolation room has a table with chairs and filing cabinets. The activity room has multiple computers for clients use. In building #2 LPA observed lockers available for clients to keep their belongings. Additionally, there are plastic totes for each client to keep their activities. In the main activity room, there are individual tables and chairs for clients use. In the back room there are activities, games and art supplies stored. LPA observed all walkways to be clean, clear, and free of obstructions and hazards. LPA observed ample lighting in all rooms. A comfortable temperature was maintained in the facility.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WORK & SERVICE COALITION
FACILITY NUMBER: 198601414
VISIT DATE: 04/28/2023
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
26
27
28
29
30
31
32
Kitchen LPA toured the kitchen and observed all appliances, cutleries, pots, and pans to be in good repair. Clients bring their own lunch and snacks daily. If needed, refrigeration and warming of food is available. There is food and snacks available for clients who forget theirs. As an activity clients will participate in cooking and baking activities. There are no knives at the facility. The water temperature measured 105.6-degrees Fahrenheit.
Bathrooms LPA checked all client bathrooms. LPA observed sufficient liquid soap and paper towels. Toilets and water faucets worked properly. All faucets are sensor activated and kept at a low temperature. LPA observed the shower to be free of mold/mildew, it is not used. All safety handrails in the bathroom were securely fastened. LPA observed all bathrooms to be in title 22 compliance.
Safety Smoke and Carbon Monoxide Detectors were tested and are fully functioning. There are two (2) fire extinguisher in building #1 and one (1) in building #2. All fire extinguishers are fully charged and last serviced on 04/26/23. The last emergency drill was conducted on 04/07/23. All exits are clearly marked, and the posted facility sketch has all exits and shut off valves marked. LPA observed all required postings throughout the facility. LPA observed multiple First Aid Kits throughout the facility, containing the required items and a manual. All cleaning supplies and toxins are secured in a locked cabinet. The program does not handle any medications. There are no security bars or firearms and ammunition stored on the premises.
Infection Control 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, and additional ones throughout the facility. A visitors log with Covid-19 screening and temperature log is kept at the entrance. LPA observed a 90-day supply of PPEs. Sufficient paper, cleaning, and disinfecting supplies were observed. LPA observed staff wearing masks. LPA observed required infection control postings throughout the facility.
Files LPA reviewed 5 client files and found they contained the required documents. LPA reviewed 6 employee file and found they contained the required documents, certification, and training. LPA reviewed and copied the facilities staff and client roster, emergency disaster plan, license, activity schedule, and plan of operation.
Interviews LPA interviewed 5 clients. All clients were happy with their services received and enjoy the program. LPA interviewed 4 staff. All staff were able to explain their process and procedures pertaining to client care and rights. LPA was informed they have programs that take them out into the community where they provide services and assistance.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report provided to Program Director Emyflair Dojillo.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2