198601422-7-7-2025-11-AS-ZBRN-DJCS83-20250707133827

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601422
Report Date: 07/07/2025
Date Signed: 07/07/2025 01:38:42 PM

Document Has Been Signed on 07/07/2025 01:38 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	CALIFORNIA EMPLOYMENT SUPPORT SERVICES, INC.		FACILITY NUMBER:	198601422
ADMINISTRATOR/ DIRECTOR:	FRANK AIFUWA		FACILITY TYPE:	775
ADDRESS:	11144 WASHINGTON BLVD		TELEPHONE:	(310) 559-2200
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY: 30		CENSUS: 28	DATE:	07/07/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Frank Aifuwa, Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:50 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 07/07/2025 at 8:30am, Licensing Program Analysts (LPA) Zina Brown made an unannounced visit to the above facility. The purpose of today's visit was to conduct an annual inspection of the facility. On today's visit LPA met with Frank Aifuwa (Administrator). The facility profile shows that the facility is licensed for a capacity of (30) developmentally disable adults of which (10) can be non-ambulatory. The Administrator stated that the facility has (28) clients currently enrolled in the program: (28) ambulatory. The staff to client ratio is (1) staff to (3) clients. The administrator stated none of the clients have restricted health care conditions or utilize any protective devices. The last disaster drill was conducted 06/27/2025. The last inspection held by the fire department was on 07/11/2024. The program does not provide transportation. The facility has a active administrator certificate (#7002124735 for Frank Aifuwa valid 08/22/2023 - 08/21/2025. The facility fees are current. Between the hours of 9:45am - 1:00 pm as a part of today's inspection LPA reviewed (5) client records, (5) staff records, and inspected the physical plant. This is a day program located in one large building consisting of the following: a receptionist area, a parking lot, a lobby area, one activity room (with computers and vending machines), a lounge area with a refrigerator and microwave and two bathroom (the water temperature correctly measures between 105°F -120°F: bathroom #1 at 110°F and bathroom #2 at 118.4°F Report continues on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Zina Brown
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CALIFORNIA EMPLOYMENT SUPPORT SERVICES, INC.	FACILITY NUMBER: 198601422
	VISIT DATE: 07/07/2025

NARRATIVE

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Between the hours of 9:02am - 9:10am, LPA conducted a tour of the physical plant with the administrator and observed the following: walls and floors were in good condition, adequate lighting and fire extinguishers were properly charged LPA observed plenty of storage space and chemicals were properly locked. The restrooms were clean and within Title 22 regulations. A refrigerator was available for client use. The day program does not provide lunch. The first aid kit was available and fully stocked. The walkways throughout the day program and all exits were clear of hazards and debris.

Under the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did observe deficiencies; and a citation was issued at this time.

Upon reviewing staff records, LPA observed that Staff #5 did not have a LIC 503 on file at the time of the annual inspection.

An exit interview was conducted with Frank Aifuwa, (Administrator) who also received a copy of the Facility Evaluation Report.

NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Zina Brown
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/07/2025 01:38 PM - It Cannot Be Edited

Created By: Zina Brown On 07/07/2025 at 12:59 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CALIFORNIA EMPLOYMENT SUPPORT SERVICES, INC.	FACILITY NUMBER: 198601422
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82066(a)(10)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (10) A health screening, as specified in Section 82065(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above for 1 out of 5 staff which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/21/2025
	Plan of Correction
1 2 3 4	The administrator will provide the Department with proof of LIC 503: Health Screening for Staff #5 by POC due date via email zina.brown@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Janae Hammond
NAME OF LICENSING PROGRAM MANAGER:

	Zina Brown
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/07/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025

LIC809 (FAS) - (06/04)

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