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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601422
Report Date: 06/21/2023
Date Signed: 06/21/2023 12:02:16 PM

Document Has Been Signed on 06/21/2023 12:02 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:CALIFORNIA EMPLOYMENT SUPPORT SERVICES, INC.FACILITY NUMBER:
198601422
ADMINISTRATOR:FRANK AIFUWAFACILITY TYPE:
775
ADDRESS:11144 WASHINGTON BLVDTELEPHONE:
(310) 559-2200
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY: 30CENSUS: 22DATE:
06/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Frank Aifuwa-AdministratorTIME COMPLETED:
12:15 PM
NARRATIVE
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 On 6/21/2023 LPA Alfonso Iniguez visited the facility unannounced. The purpose of today's visit was to conduct an unannounced annual inspection of the facility. On today's visit, LPA met with facility staff Frank Aifuwa-Administrator. The facility profile shows that the facility is licensed for a capacity of (30) clients, of which (10) may be non-Ambulatory. The administrator stated that the facility has (22) clients enrolled in the program. The total number of non-ambulatory clients attending the program is (0). The staff-to-client ratio is (3) staff to (1) clients. Director stated that the facility has (0) clients with a Restricted Health Care condition. Currently, there are (0) clients using protective devices. The facility conducted a fire drill on 5/27/2023, and a Disaster Plan was on file. The last inspection held by the fire department was on 1/9/2023. The program does not provide transportation.

As a part of today's inspection, LPA reviewed 5 client records(see D page for citations), 5 staff records, and inspected the entire facility inside and out. LPA and administrator toured the entire facility. The facility is a one-story structure located in a commercial area. It consists of the following: Main Entry Lobby Area, partitioned computer area, partitioned seating area, lunch area / staff break area, and two (2) bathrooms. There was one (1) parking lot with wheelchair access (drop off/pick up area). There were no bodies of water or obstructions on the premises.

Evaluation Report continues LIC 809-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CALIFORNIA EMPLOYMENT SUPPORT SERVICES, INC.
FACILITY NUMBER: 198601422
VISIT DATE: 06/21/2023
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Inside areas are free of hazards and obstructions. (2) restrooms have working toilets and wash basins. They will accommodate non-ambulatory clients in a wheelchair. Emergency Phone Numbers are Posted & readily available for review in the activity area. Fire Extinguishers are up to fire code. The facilities telephone system is working correctly.
Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured in bathroom #1 was 114.5° F. In the bathroom, #2 was 109.7° F. A comfortable temperature is maintained in the facility. Smoke detectors and carbon monoxide alarm system is build-in and checked by the fire department every year. The facility is equipped with central air and heat. Toxins were stored and inaccessible to clients in lunch area.
A first aid kit has been inspected, with at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual, which are stored in locked steel drawers, available for staff use but inaccessible to clients.
The facility does not handle the cash resources of clients and medications.

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8.

See D pages for Citations.

Exit interview conducted and a copy of the appeal rights were given to Frank Aifuwa/Administrator at the time of the visit.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/21/2023 12:02 PM - It Cannot Be Edited


Created By: Alfonso Iniguez On 06/21/2023 at 11:47 AM
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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CALIFORNIA EMPLOYMENT SUPPORT SERVICES, INC.
FACILITY NUMBER: 198601422

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82069(b)(1)
Client Medical Assessments
(b) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review the licensee did not comply with the section cited above in having the TB test in client's files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2023
Plan of Correction
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Licensee will ensure client's TB test will be in their files at all time. A proof of correction must be submitted to LPA before POC due date via email.
Type B
Section Cited
CCR
82071(a)
Register of Clients
(a) The licensee shall maintain in the program site a register of all clients. The register shall be updated as needed; shall be immediately available to, and copied for, licensing staff upon request; and must contain current information on the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review the licensee did not comply with the section cited above in maintaining clients records updated which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2023
Plan of Correction
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Licensee will ensure client records are updated at least once a year. Licensee must create a rocords review form and sent proof to LPA via email before POC due date.
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:Eva M Alvarez
LICENSING EVALUATOR NAME:Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


LIC809 (FAS) - (06/04)
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