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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601433
Report Date: 06/21/2022
Date Signed: 06/21/2022 08:06:44 PM

Document Has Been Signed on 06/21/2022 08:06 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:WISE ADULT DAY SERVICE CENTERFACILITY NUMBER:
198601433
ADMINISTRATOR:CATHERINE JONASFACILITY TYPE:
775
ADDRESS:1527 4TH STREETTELEPHONE:
(310) 394-9871
CITY:SANTA MONICASTATE: CAZIP CODE:
90401
CAPACITY: 60CENSUS: 18DATE:
06/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Grace Cheng Braun - President and CEOTIME COMPLETED:
01:00 PM
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On 06/21/2022, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with President and CEO Grace Cheng Braun and explained the purpose of today’s visit. The facility is licensed for sixty (60) ambulatory clients of which ten (10) may be non-ambulatory.

The facility is a three-story structure of which the day program occupies the second floor. Facility grounds consists of two (2) activities rooms, storage rooms, copy room, client liaison room, activities supervisor room, quiet room, director’s office, transportation office, staff room, staff break room, kitchen with a pantry, private dining room, and three (3) bathrooms of which one is unisex and one is men’s restroom and one is women’s restroom. Common areas were observed to be clean, operational, and properly furnished. There is also an outdoor patio area for clients to utilize with tables and chairs.

LPA and President/CEO toured the physical plant. There were no bodies of water or obstructions on the premises. Bathrooms were found to be within Title 22 regulations and were clean and operational.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage area cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. Three (3) fire extinguishers were observed to be fully charged – one near the back restroom in the main activity room, one outside of the Director’s office and one inside the kitchen as you enter on the left. First aid kit available in the main activity room.

Continued on LIC 812-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2022
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
MONTEREY PARK, CA 91754
FACILITY NAME: WISE ADULT DAY SERVICE CENTER
FACILITY NUMBER: 198601433
VISIT DATE: 06/21/2022
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During the visit, LPA observed the facility infection control practices. LPA observed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

No deficiencies were cited during this inspection visit.

One technical violation was issued. See 9102 page.

An exit interview was conducted, and a copy of this report was provided to the President and CEO Grace Cheng Braun.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC809 (FAS) - (06/04)
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