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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601422
Report Date: 07/15/2022
Date Signed: 07/15/2022 01:09:55 PM

Document Has Been Signed on 07/15/2022 01:09 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
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: 20DATE:
07/15/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Frank AifuwaTIME COMPLETED:
01:15 PM
NARRATIVE
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Infection Control
During the visit, LPA Johnson observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and clients. Sanitizing stations are in common areas and restrooms. LPA Johnson observed staff was wearing face coverings. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of staff and resident temperature logs were reviewed. The facility has a Mitigation Plan Report approved by CCLD on file.

Deficincies
Based on the facility tour, the licensee violated the California Code Regulations (CCR) of Title 22 sections 80087 Division 6 Chapter 1. On 07/15/22 (9:47am) LPA Johnson observed On 07/15/22 (9:47am), LPA Johnson observed observed the bathroom sink faucet was in disrepair.

Plan of Correction


Licensee stated that the facility will have the bathroom sink repaired by 07/31/22. This citation must be corrected by POC 07/31/2022.


An exit interview was conducted with Frank Aifuwa. A copy of this report was printed and provided to Frank Aifuwa.

End of report

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Gail Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2022
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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Document Has Been Signed on 07/15/2022 01:09 PM - It Cannot Be Edited


Created By: Gail Johnson On 07/15/2022 at 12:12 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 DR #100
MONTEREY PARK, CA 91754

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2022
Section Cited
CCR
80087(a)

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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not as evidenced by:
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Licensee stated that the facility will have the bathroom sink repaired by 07/31/22. This citation must be corrected immediately by POC 07/31/2022.
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On 07/15/22 (9:47am), LPA Johnson observed observed the bathroom sink faucet was in disrepair. The water was not running properly. The top of the faucet stopper was missing.
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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:Eva M Alvarez
LICENSING EVALUATOR NAME:Gail Johnson
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022


LIC809 (FAS) - (06/04)
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