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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601530
Report Date: 04/27/2023
Date Signed: 04/27/2023 04:03:06 PM

Document Has Been Signed on 04/27/2023 04:03 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:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Loveday Chinaka, AdministratorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. Upon arrival, LPA met 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 will expire on 4/1/2024. Facility annual fees are current.

During the visit, the CARE tool was used, a tour of the facility was conducted, food supply was reviewed, staff / client files were reviewed, staff / clients were interviewed, and medications were reviewed.

The facility 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. It is a single-family home located in a residential neighborhood. Common areas were observed for the ability to safely serve the needs of the clients. All client rooms were furnished with appropriate furniture for clients’ comfort. The bathrooms were furnished with grab bars and nonskid surfaces. Hot water temperature was 115.5 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. The last Fire/ Emergency Drill was conducted on 3/26/23 . (-continued in LIC 809C-)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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
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: 04/27/2023
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Fire extinguishers were fully charged and last service was 3/31/23. 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 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: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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