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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601606
Report Date: 03/08/2023
Date Signed: 03/08/2023 01:21:36 PM

Document Has Been Signed on 03/08/2023 01:21 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, 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: 30DATE:
03/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Angel Christopher - Program DirectorTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Mario Leon made an unannounced Required - 1 Year inspection to the above Adult Day Program (ADP). LPA Leon met with Ms. Angel Christopher, Program Director, and Ms. Ariel Sanchez, Program Supervisor . LPA Leon informed staff that the purpose of today's visit was to inspect the day program physical plant, review staff and client’s records. LPA Leon verified current staff fingerprints that are cleared and associated to the facility. The ADP annual fees are current. The ADP is vendored by Westside Regional Center (WRC).

The Adult Day Program is located in a single story commercial building, operating hours are 8:30 A.M. to 2:30 P.M., 5 days a week Monday thru Friday. All clients bring their own lunch or bring money to purchase lunch in the community. If clients forget their lunch the facility staff will provide emergency food for clients, such as spaghetti or other noodles.

LPA Leon and Ms. Angel Christopher, toured the entire Adult Day Program inside and out which consisted of the following: The ADP is located in suite 101, there are 4 activity rooms one of which is the computer room, 2 staff offices, living room, kitchen, 2 restrooms, outdoor shaded area, and a parking lot. All areas are in compliance. Each room is adequately equipped and furnished. The day program has posted current activity schedules, and each instructor develops and follows specific daily and weekly schedules.

See LIC809-C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA GARDENA
FACILITY NUMBER: 198601606
VISIT DATE: 03/08/2023
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The staff to consumer’s ratio is 1 staff to 3 consumers. The last Fire/Emergency Drill was conducted on 2/16/2023.

The staff in-service training was reviewed. The employee personnel files and client records are in a locked cabinet and were reviewed and appear to be in compliance.

Ms. Christopher states staff was given training on dependent adult and elder abuse reporting, SOC341A. The day program currently has zero clients on medications. However, the ADP has a locked cabinet for medications. There are no personal/incidental monies handled by the day program staff.

Documents are posted as mandated. The following Title 22 regulated areas were audited and found to be in compliance: Hot water temperature measured at 106.1 F, first aid kit is fully stocked with manual, carbon monoxide and smoke detectors were in compliance, fire extinguishers are fully charged, Facility walls and floors were in good condition, adequate lighting was provided, restrooms are clean and operational, toxic/sharp items were properly locked, inaccessible to clients. Hazardous items are inaccessible to clients. There is plenty of storage space. The day program grounds are free of debris/hazards.

There was one deficiency observed.

An exit interview was conducted and a copy of this report was provided to Ms Angel Christopher, Program Director .
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/08/2023 01:21 PM - It Cannot Be Edited


Created By: Mario Leon On 03/08/2023 at 01:00 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
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA GARDENA
FACILITY NUMBER: 198601606

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82066(a)(10)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (10) A health screening, as specified in Section 82065(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, the licensee did not comply with the section cited above in not having updated health screening for staff member Charles Davis which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2023
Plan of Correction
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LPA and Program Director, Angel Christopher, have agreed that Easter Seals will locate and provide an updated health screening for staff. The health screening will be submitted, via email, to Mario.Leon@DSS.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:Ulysses Coronel
LICENSING EVALUATOR NAME:Mario Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2023


LIC809 (FAS) - (06/04)
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