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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601606
Report Date: 03/10/2022
Date Signed: 03/10/2022 11:28:44 AM

Document Has Been Signed on 03/10/2022 11:28 AM - 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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA GARDENAFACILITY NUMBER:
198601606
ADMINISTRATOR:SANKA, DIANE FFACILITY TYPE:
775
ADDRESS:1919 W REDONDO BEACH BLVDTELEPHONE:
(310) 542-2148
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 35CENSUS: 34DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Angel ChristopherTIME COMPLETED:
11:50 AM
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03/10/22, Licensing Program Analysts (LPA) Gail Johnson conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA Johnson met with the Program Director Angel Christopher. LPA Johnson explained the purpose of today’s visit. The facility is licensed to operate 35 clients (15 may be ambulatory and 20 may be non-ambulatory) adults ages 18 and above. Currently, the facility provides a hybrid service. Staff meet with clients virtually, and in outdoor environments.

Facility Structure
The facility is a one-story structure located in a commercial area. It consists of the following: Living room, storage area, three (3) office room spaces, one (1) bathroom, kitchen and three (activity rooms numbered one (1) – three (3). Activity room three (3) may be used as an isolation room if and or as necessary.Physical Plant LPA Johnson toured the physical plant. There were no bodies of water or obstructions on the premises. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 108.0 degrees F. Storage & Inaccessible Items Storage areas for cleaning supplies, toxins, and sharp objects were stored and not accessible to clients. The kitchen was inspected and found as clean and in adequate condition. Emergency Phone Numbers & Exit Plan,: Emergency numbers are posted and readily available for review in lobby the under the Emergency Exit Plan. Facility has two (2) land line telephones located in two office spaces. First aid kit was not expired and fully supplied with essential items and the manual. One (1) fire extinguisher was fully charged. Smoke detectors and carbon monoxide detectors were operable.

Evaluation Report Continues on LIC 809-C


SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Gail Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA GARDENA
FACILITY NUMBER: 198601606
VISIT DATE: 03/10/2022
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Infection Control
During the visit, LPA Johnson observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. Sanitizing stations in common areas and restrooms. LPA Johnson observed staff was wearing face coverings. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of staff and resident temperature logs were reviewed. The facility has a Mitigation Plan Report approved by CCLD on file.


An exit interview was conducted with Angel Christopher. A copy of this report was printed and provided to Angel Christopher.

End of report

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Gail Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC809 (FAS) - (06/04)
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