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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601530
Report Date: 05/10/2024
Date Signed: 05/10/2024 03:57:48 PM

Document Has Been Signed on 05/10/2024 03:57 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA PROSPERO HOMEFACILITY NUMBER:
198601530
ADMINISTRATOR/
DIRECTOR:
SAMUEL BENEDICT B CABARONFACILITY TYPE:
735
ADDRESS:1046 N PROSPERO DRTELEPHONE:
(626) 339-1482
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 4CENSUS: 4DATE:
05/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:12 PM
MET WITH:Loveday Chinaka, DirectorTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with Director, Loveday Chinaka, and explained the reason for the visit. The facility is licensed to serve 4 developmentally disabled clients, ages 18-59, of which 2 may be non-ambulatory. There are currently 4 residing at the home.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tool to inspect the facility. The following were observed:

Physical Plant & Environmental Safety: The single family home consists of 4 Client bedrooms, a Staff office, 2 bathrooms, dining room, kitchen, living room, laundry area and a detached garage. There is no swimming pool on the premises. The backyard is equipped with tables and chairs for clients to use. The fireplace is secured with a cover. There are no items obstructing the hallways or passageways. All the bedrooms have the required furniture such as a chair, night stand, and sufficient lighting. Food supplies are sufficient with 2 day perishable and at least a week of non-perishable items. The facility has smoke and carbon monoxide combo detectors connected throughout the home. Knives, sharps, and cleaning supplies are locked in the kitchen area. Medications are centrally stored and locked. The facility measures the hot water temperature weekly and documented.
Operational Requirements: The facility is operating within the approved fire clearance. The staff are providing the care and supervision according to the needs of the clients.
Infection Control: The facility continue to follow their infection control plan. They are continuing to clean and disinfect daily and more often for high touched surfaces. They are following proper hand hygiene and wearing gloves when assisting clients.

There are no deficiencies observed today. LPA will return another day to complete the remainders of the domains. An exit interview was held and a copy of this report was given to the Director.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2024
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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