<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601530
Report Date: 05/25/2022
Date Signed: 05/25/2022 12:39:39 PM

Document Has Been Signed on 05/25/2022 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA PROSPERO HOMEFACILITY NUMBER:
198601530
ADMINISTRATOR:LOVEDAY CHINAKAFACILITY TYPE:
735
ADDRESS:1046 N PROSPERO DRTELEPHONE:
(626) 339-1482
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 4CENSUS: 4DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Loveday Chinaka, AdministratorTIME COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. Upon arrival, LPA met with Administrator, Loveday Chinaka, who assist with today's visit. The facility is licensed to serve four (4) developmentally disabled clients, ages 18-59. The facility is approved for two (2) non ambulatory clients. Client census is four (4). No clients have a restricted health condition. Administrator certificate is current and expires on 04/01/2023. Facility annual fees are current.

During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed.

The facility is a single house located in a residential neighborhood and consisted of four (4) client bedrooms, two (2) bathrooms, a living room, a dining area, a kitchen, an office, laundry area, a detached garage and an outdoor activity area in the back yard. All client rooms were furnished with appropriate furniture for clients’ comfort. The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the clients. Hot water temperature was 112.7 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. Facility maintained a comfortable temperature for clients. Sufficient supply of perishable and non-perishable foods were observed. Back yard activity area was a shaded area with chairs and free of debris/ hazard. Smoke and carbon monoxide detectors were dual, hardwired and operable. First aid kit was fully stocked with manual. The last Fire/ Emergency Drill was conducted on 05/04/22.
(-continued in LIC 809C-)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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 2
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA PROSPERO HOME
FACILITY NUMBER: 198601530
VISIT DATE: 05/25/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Fire extinguishers were fully charged and last service was 8/28/21. Medications were centrally stored, locked and the records were current. Hazardous items, knives and sharp items were locked and inaccessible to clients.

No deficiencies were cited per per California Code of Regulations, Title 22.

Exit conference was conducted with administrator. This report, LIC 809s, were provided to administrator.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2