<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601731
Report Date: 08/30/2024
Date Signed: 08/30/2024 01:54:39 PM

Document Has Been Signed on 08/30/2024 01:54 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA CRENSHAWFACILITY NUMBER:
198601731
ADMINISTRATOR/
DIRECTOR:		DANKA, DIANE FFACILITY TYPE:
775
ADDRESS:14800 CRENSHAW BLVDTELEPHONE:
(310) 329-1161
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 35CENSUS: 26DATE:
08/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Program Director - Angel Christopher-EvansTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/30/2024 at around 11:00 AM, Licensing Program Analyst (LPA), Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Program Director, Angel Christopher-Evans. LPA explained the purpose of the visit and was accompanied by a staff-member inside and outside the facility during this inspection.

This facility is licensed to serve 35 adults ages 18 – 59 years, of which 25 may be non-ambulatory clients.

A total of 26 clients are currently registered in this facility.

The Annual Licensing Fees are current.

The facility is a one-story commercial building located on a main street. The facility consists of 2 office spaces, 1 living room, 3 bathrooms, 1 computer lab, 3 work rooms, 1 kitchen/activity room, 1 refreshing room, 1 storage room, 1 nurse's office, and a parking lot.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 08/30/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA toured the kitchen area and observed knives and toxins were kept in locked storage cabinet. LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last fire drill was conducted on 08/14/2024. First aid kit is fully stocked with manual. There are several fire extinguishers on the premises, and they were last serviced on 08/20/2024. The last Fire Inspection was conducted on 09/15/2023. Bathroom toilets and water faucets worked properly. Adequate lighting and toiletries accessible to clients. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit.

5 staff records were reviewed, 5 out of 5 staff records had required documentation.

5 client records were reviewed and, 5 out of 5 client records had required documentation.

No deficiencies are being cited based on LPA observation and record review in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted, and a copy of this report was left with the Administrator.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2