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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601731
Report Date: 09/25/2023
Date Signed: 09/25/2023 11:19:47 AM

Document Has Been Signed on 09/25/2023 11:19 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA CRENSHAWFACILITY NUMBER:
198601731
ADMINISTRATOR:DANKA, DIANE FFACILITY TYPE:
775
ADDRESS:14800 CRENSHAW BLVDTELEPHONE:
(310) 329-1161
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 35CENSUS: 13DATE:
09/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:Angel Christopher EvansTIME COMPLETED:
11:35 AM
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On 09/25/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced Required-1 Year visit using the New Care Inspection Tools to the above Adult Day Program (ADP). LPA Richard met with Program Director Angel Christopher-Evans and Program Supervisor Valerie Walsh. LPA Richard informed staff that the purpose of today's visit was to inspect the day program physical plant, review staff and client’s records. LPA Richard 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 8:00 AM. to 2:30 PM., 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.

Ms. Christopher-Evans and LPA Richard toured the entire Adult Day Program inside and out which consisted of the following: Reception area/ lobby, administrative offices, kitchen/multi-purpose room, art and crafts room, activity room, nurse's room, media lounge room, changing room, storage room, men's and women's restrooms and a community 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 weekly schedules.

See continued LIC809-C on page #2
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2023
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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA CRENSHAW
FACILITY NUMBER: 198601731
VISIT DATE: 09/25/2023
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Continued LIC809-C page #2

The staff to consumer’s ratio is 2 staff to 3 consumers. The facility has consumers with a Restricted Health Care condition and consumers with who use protective helmets. The last Fire/Emergency Drill was conducted on 08/24/2023.

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-Evans states staff was given training on dependent adult and elder abuse reporting. The day program currently has one client on medication. The medication is centrally stored in a locked cabinet in hallway in the back next to the nurse's room and records are current. 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: The Hot water temperature measured at 109.1F degrees Fahrenheit, carbon monoxide and smoke detectors were in compliance, fire extinguisher are fully charged, rest-rooms are clean and operational, toxic/sharp items locked inaccessible to clients. Hazardous items are inaccessible to clients and first aid kit is fully stocked with manual. The day program grounds are free of debris/hazards.

There were no deficiencies cited.

Exit interview conducted.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023
LIC809 (FAS) - (06/04)
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