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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601468
Report Date: 03/15/2024
Date Signed: 03/15/2024 03:40:05 PM

Document Has Been Signed on 03/15/2024 03:40 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:MYCHAL'S LEARNING PLACEFACILITY NUMBER:
198601468
ADMINISTRATOR:EDWARD LYNCHFACILITY TYPE:
775
ADDRESS:4901 W. ROSECRANS AVETELEPHONE:
(310) 297-9333
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 45CENSUS: 41DATE:
03/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Administrative Program Director, Prescila TranTIME COMPLETED:
04:00 PM
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On 03/15/2024 Licensing Program Analyst (LPA), David España, conducted an unannounced annual visit using the full Care Tools. LPA met with Assistant Program Director, Prescila Tran and explained the purpose of this visit and went over the new Entrance Checklist. Currently the facility has 41 clients registered and 23 were present at the facility during the time of the visit. The program hours are from 8:30am till 2pm. The facility has an after-school program that operates from 2pm till 6pm. LPA España toured the facility with Assistant Program Director, Prescila Tran and observed the following: Entrance door leads to waiting area and receptionist/ information desk, Five (5) administrative offices, supply (resource) room, Back Room for clients to check-in and review daily activities, conference room (Print and Embroidery display room), multi-purpose activity area/ room, commercial kitchen, laundry room, art room, quiet room/isolation room (mock bedroom), music room, women and men’s restroom. There is a large room "Big Purple Room", used for fitness/exercise and other activities (mainly used so consumers can spread apart). All rooms were clean, organized, and appropriately furnished to accommodate all residents and spacing. All walkway were clean, clear, and free of hazards, obstructions or debris. LPA did not observe any bodies of water. Continued on LIC809C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: MYCHAL'S LEARNING PLACE
FACILITY NUMBER: 198601468
VISIT DATE: 03/15/2024
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LPA inspected the facilities industrial kitchen. All appliances were in good working order. As part of the program, client’s help bake, cook and maintain the kitchen. The facility has two food trucks, and caters. LPA observed all cutleries, pots, and pans to be in good repair. LPA observed all food to be properly stored and labeled. All sharps are secured in a locked drawer and are inaccessible to residents. The hot water temperature measured 119.4-degrees Fahrenheit. All toxins and cleaning supply are secured in a locked storage room and inaccessible to residents. LPA observed the client’s daily menus made by the clients. LPA observed the kitchen to be clean and sanitary. LPA inspected all bathrooms in the facility. LPA observed the restrooms to be clean, sanitary, and fully functioning. All toilets and sinks are fully operable. All restrooms are handicapped accessible. LPA observed an ample supply of hand soap and paper towels. The hot water temperature measured between 111 degrees and 112 degrees Fahrenheit in the women’s restroom and between 113 degrees and 113 degrees Fahrenheit in the men’s restroom. The facility is equipped with hard-wired smoke and carbon monoxide detectors and sprinklers that was last inspected by the Fire Marshal on 05/27/22. LPA observed multiple fully charged fire extinguishers last serviced on 07/15/23. Last emergency drill was conducted on 12/2023. LPA observed and inspected Two (2) First Aid Kits, one located in the kitchen and the other in the laundry room. They are fully stocked and contain all the required items and a manual. LPA reviewed the Emergency Disaster Plan (LIC610E) for the facility. All entrance/exit doors are marked and accessible for non-ambulatory consumers. There is a working landline at the facility. Continued on LIC809C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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: MYCHAL'S LEARNING PLACE
FACILITY NUMBER: 198601468
VISIT DATE: 03/15/2024
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During visit, LPA observed the facilities Infection Control procedures. Upon entry all staff, clients and visitors are screened, and temperature taken. At the entrance is a hand sanitizing station and masks are available for people entering the facility. LPA observed all staff wearing masks and some of the clients. LPA observed Infection Control signs posted throughout the facility.

LPA reviewed Five (5) staff files and found they contain the required documents, certification, and training. LPA reviewed (5) consumer files and found they contained the required documents. LPA interviewed Five (5) staff. LPA reviewed the current admission and intake documents, including the admission agreement, client handbook and personal rights. LPA observed all required posting including license, personal rights, nondiscrimination policy, “see something, say something,” and activity schedule.

No deficiencies were cited.

LPA conducted final interview with Administrative Program Director, Prescila Tran and a copy of this report was provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC809 (FAS) - (06/04)
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