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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601740
Report Date: 06/22/2022
Date Signed: 06/22/2022 11:36:37 AM

Document Has Been Signed on 06/22/2022 11:36 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:QUALITY OF LIFE ACADEMYFACILITY NUMBER:
198601740
ADMINISTRATOR:NNAEMEKA EZENAGUFACILITY TYPE:
775
ADDRESS:8439 CALIFORNIA AVENUETELEPHONE:
(562) 372-4750
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY: 66CENSUS: 48DATE:
06/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Program Manager, Evelyn Prado TIME COMPLETED:
11:51 AM
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Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced visit for the purpose of conducting the required annual inspection. On today's visit LPA met with program manager, Evelyn Prado who assisted with the visit. Facility has 34 in-person clients and 14 alternative clients.

The facility is vendorized through South Central Regional Center and is licensed to served 66 clients between the age of 18 and above, ambulatory only. The facility has 2 single story buildings and a garage (Licensee office). Building #1 contains 1 classroom and 1 restroom. Building #2 contains 1 classroom, 2 restrooms, office, quiet area, and a kitchen.

LPAs discussed infection control practices with program manager and director, toured the facility inside and out, reviewed food supply, reviewed staff files, and reviewed resident medications.

Report Continued on 809c

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2022
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: QUALITY OF LIFE ACADEMY
FACILITY NUMBER: 198601740
VISIT DATE: 06/22/2022
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During today’s visit LPA observed all indoor and outdoor passages were free of obstruction. All Bathrooms were observed to be clean and stocked with soap and paper towels. The facility serves breakfast, snack, and lunch. LPA toured the kitchen and observed 7 days of nonperishable and 2 days of perishables. Hazardous toxins and/or sharp items are inaccessible to clients. The hot water temperature measured in bathroom of building #1 at 105.2 and bathroom of building #2 between 107.8- 111.0 degrees F., which is within the required 105 - 120 degrees F. There are no large bodies of water on the premises such as pools. The grounds are well groomed and there were no hazards observed. Cleaning supplies are inaccessible to clients. Trash containers have covered lids. LPA observed that required documents are posted as mandated. LPA observed 30 days of PPE supplies located in a locked shed. First aid kit is fully stocked with manual, smoke detectors and carbon monoxide detector tested and operational. LPA observed locked cabinet for medication. The facility is in good repair. During the visit, LPA observed the facility infection control practices.


Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided to Program Manager, Evelyn Prado.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
LIC809 (FAS) - (06/04)
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