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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601433
Report Date: 05/29/2024
Date Signed: 05/29/2024 04:17:54 PM

Document Has Been Signed on 05/29/2024 04:17 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:WISE ADULT DAY SERVICE CENTERFACILITY NUMBER:
198601433
ADMINISTRATOR/
DIRECTOR:		CATHERINE JONASFACILITY TYPE:
775
ADDRESS:1527 4TH STREETTELEPHONE:
(310) 394-9871
CITY:SANTA MONICASTATE: CAZIP CODE:
90401
CAPACITY: 60CENSUS: 25DATE:
05/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Rachel Sangestanian, Director of Adult Day CenterTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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On 05/29/2024 Licensing Program Analyst (LPA) David España conducted an unannounced Required-1-year annual visit using the full CAREs tool. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection (No COVID-19 cases). LPA verified that the facility has an approved mitigation plan report. LPA was granted access and allowed to enter the facility to conduct the inspection.

LPA met with Molly Davies, President and CEO of Adult Day Center and explained the purpose of today’s visit. We were later joined by Rachel Sangestanian, Director of Adult Day Center. The facility is licensed for a capacity of (60) clients, of which (10) may be non-Ambulatory. The director stated that the facility has (25) clients enrolled in the program. The total number of non-ambulatory clients attending the program is (0). The staff-to-client ratio is (1) staff to (4) 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 04/30/2024 and a Disaster Plan was on file. The last inspection held by the fire department was on 05/23/2024. The program does not provide transportation. Evaluation Report continues LIC 809-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: WISE ADULT DAY SERVICE CENTER
FACILITY NUMBER: 198601433
VISIT DATE: 05/29/2024
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As a part of today's inspection, LPA reviewed 5 client records, 5 staff records, and medications and inspected the entire facility inside and out. LPA and Molly Davies, President and CEO toured the entire facility. The facility is a three-story building of which the day program occupies the second floor. Facility grounds consists of two (2) activities rooms, storage rooms, copy room, conference room, activities supervisor room, quiet room, director’s office, staff room, staff break room, kitchen with a pantry (not accessible to clients), dining room, and three (3) bathrooms of which one is used by staff, and the other are used by clients. Common areas were observed to be clean, operational, and properly furnished. There is also a shaded outdoor patio area for clients to utilize with tables and chairs. 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 113° F. In the bathroom, #2 was 106° 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 kitchen 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.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: WISE ADULT DAY SERVICE CENTER
FACILITY NUMBER: 198601433
VISIT DATE: 05/29/2024
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The facility does not handle the cash resources of clients. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Rachel Sangestanian, Director of Adult Day Center.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC809 (FAS) - (06/04)
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