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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601527
Report Date: 09/06/2024
Date Signed: 09/06/2024 06:54:31 PM

Document Has Been Signed on 09/06/2024 06:54 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:MONETA LEARNING CENTERFACILITY NUMBER:
198601527
ADMINISTRATOR/
DIRECTOR:		ANITA MATHARUFACILITY TYPE:
775
ADDRESS:21601 MONETA AVENUETELEPHONE:
(310) 782-9701
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 32CENSUS: 32DATE:
09/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:12 AM
MET WITH:Pat BallTIME VISIT/
INSPECTION COMPLETED:
01:33 PM
NARRATIVE
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On 09/06/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Executive Program Director Pat Ball and explained the purpose of today’s visit. The day program is licensed to operate for thirty-two (32) non-ambulatory ages 18 and over. The consumers are Harbor Regional Center clients. Currently, the program is conducting services though visual communications with consumers.

The day program is a single-story structure located in a residential neighborhood. It consists of the following: administrative office, consultation area, conference room, physical activity room, arts and crafts room, controlled multi-sensory stimulation room(SPA), computer lab area, break room/kitchen area, laundry area, nurse's room, and two (2) designated restrooms.

LPA and director toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected and had adequate lighting furnishings. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 112.1 F. A comfortable temperature of 73 degrees was maintained.

LPA observed the day program to be sanitary and appropriately supplied at the time of visit. Storage room for cleaning supplies, toxins, and sharps objects were stored and not accessible to consumers. The kitchen was inspected and found all appliances were in working condition. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable. The first Aid kit was adequately supplied. A landlne telephone was in working condition. Inspection

Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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: MONETA LEARNING CENTER
FACILITY NUMBER: 198601527
VISIT DATE: 09/06/2024
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During this visit, LPA’s observed the day program's infection control practices. LPA observed screening protocols for visitors, staff, and consumers, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings,. All mandated inspection control posters were posted. The program has a dedicated isolation/quarantine room.

An audit of clients #1-#5 (C1-C5) service files and staff #1-#5 (S1-S5) personnel files was conducted. The facility is current on Community Care Licensing annual dues.

Deficiency:
During an audit of personal staff #1 had expired CPR/First Aid and staff #2 did not have CPR/First Aid on file. Staff #1-#5 are all not Criminal Clearance Transfer and not associated to the facility with a LIC 9162 on file. Staff #2 did not have an LIC 503 Health Screening or TB test results on file.

According California Code of Regulations (Title 22, Division 6, Chapter 3), deficiencies were observed, and citations were issued (ref. LIC 9099-D).

An exit interview was conducted with Pat Ball and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/06/2024 06:54 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 09/06/2024 at 12:30 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MONETA LEARNING CENTER
FACILITY NUMBER: 198601527

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82019(e)(3)
Criminal Record Clearance
(e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following: (3) Request the licensee or applicant for a license to request a transfer of a criminal record clearance as specified in Section 82019(f); or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above. LPA identifed Staff #1-#5 all did not have Criminal Clearance Transfer. (S1-S5) all were not associated in CDSS Guardian.This violation which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/07/2024
Plan of Correction
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LIcensee/Program Direction must adhere to Title 22 82019(e)(3) and ensure that all staff must have Criminal Clearance Transfer association in CDSS Guardian prior to employment. LIcensee will associate each staff #1-#5 in Guardian or send an LIC 9162 to CDSS by POC due date via email: ernand.dabuet@dsss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Janae Hammond
LICENSING EVALUATOR NAME:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/06/2024 06:54 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 09/06/2024 at 12:31 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MONETA LEARNING CENTER
FACILITY NUMBER: 198601527

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82065(g)(1)
Personnel Requirements
(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above. LPA identifed Staff #2 did not have a LIC 503 Health Screening nor TB Test Results on file. This violation which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/20/2024
Plan of Correction
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LIcensee/Program Direction must adhere to Title 22 82065(g)(1) and ensure that all staff prior to employment must have a health screening and TB test results completed. Licensee will send an LIC 503 and TB test results for staff #2 to CDSS by POC due date via email: ernand.dabuet@dsss.ca.gov
Type B
Section Cited
CCR
82075(f)
(f) Staff responsible for providing direct care and supervision shall receive and maintain current training in first aid and cardiopulmonary resuscitation from persons qualified by agencies including, but not limited to, the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above. LPA identified staff #1 and #4 did not have current CPR/First Aid certificate completed. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/20/2024
Plan of Correction
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Licensee/Program must adhere to Title 22 82075(f) and ensure that all staff with direct care to consumers must have a current and completed CPR/First Aid Certificate on file. LIcensee will send correction for staff#1 & #4 CPR/First Aid to ernand.dabuet@dss.ca.gov by POC due date.
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:Janae Hammond
LICENSING EVALUATOR NAME:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2024


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