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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601475
Report Date: 09/27/2022
Date Signed: 09/27/2022 12:39:18 PM

Document Has Been Signed on 09/27/2022 12:39 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA LA TIJERAFACILITY NUMBER:
198601475
ADMINISTRATOR:DANKA, DIANE FFACILITY TYPE:
775
ADDRESS:7910 LA TIJERA BLVDTELEPHONE:
(310) 329-1161
CITY:WESTCHESTERSTATE: CAZIP CODE:
90045
CAPACITY: 35CENSUS: 15DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Greta GoreeTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Perry Scott conducted a site visit for the 1-year annual inspection, with a primary focus on Infection Control measures using the new CARE Inspection Tool. On today’s visit LPA met with facility representative, Greta Goree, and the purpose of the visit was explained. Upon entry, my temperature was taken, and I was presented with a visitor’s log to sign in. All staff were complying by wearing face coverings. The facilities annual fees are currently outstanding with a balance of $454.00 that was due on 12/15/2021.

As part of the inspection, my primary focus was on infection control. LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff and clients; and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility has the mandated COVID infection control posters.



The facility is licensed to serve thirty-five (35) Developmentally Disabled Clients ages 18 and above; of which twenty (20) Clients may be non-ambulatory. The program currently has fifteen (15) non-ambulatory clients of which three (3) clients have restricted health conditions. Disaster/Fire Drill was conducted on: 08/18/2022. LPA conducted a tour of the facility which includes: Lobby, living room, program offices, three (3) work rooms, one (1) men's bathroom, one (1) ladies’ bathroom, refreshing room, nurse's office, common area, conference room, isolation room, computer lab, kitchen, and pantry area. All rooms were complying within title 22 regulations.


Continued on LIC 809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA LA TIJERA
FACILITY NUMBER: 198601475
VISIT DATE: 09/27/2022
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LPA observed that licensee is not operating beyond the conditions and limitations specified on the license, including the capacity limitation. Clients are protected against hazards. There are no pools or bodies of water present on the premises. Disinfectants, cleaning solutions, poisons, knives/ sharp objects are inaccessible to clients. The licensee ensures safe and healthy indoor activity space for clients. All fire extinguishers are fully charged.

A comfortable temperature for clients is maintained. Hot water temperature measured between 105 degrees F and 120 degrees F. All toilets and hand washing facilities are maintained in a safe, sanitary, operating condition. Clients provide their own lunch. Facility has refrigerator, microwave, stove, dishwasher, oven, sink. First Aid Kit was fully stocked, and a manual was available.

During the visit, LPA observed the following to be complying: the facility's infection control practices; screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms; all staff were wearing a face covering; the facility has a 90-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.

No deficiencies were cited during today’s visit.

A copy if this report is being furnished to the facility representative, Greta Goree.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
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