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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601740
Report Date: 07/11/2023
Date Signed: 07/11/2023 01:50:57 PM

Document Has Been Signed on 07/11/2023 01:50 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
GREATER LA AC/SC, 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: 42DATE:
07/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Joshua Corzantes, Program DirectorTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced annual inspection. LPA Pena was met by the Program Director, Joshua Corzantes and explained the purpose of today's visit. The facility consists of 2 single-storey buildings within the city of South Gate. It is licensed to serve clients age range 18 and over, 66 ambulatory only. All clients at the program receive case management services provided by South Central Regional Center. The day program consists of Building #1: activity room, thirty six (36) participant storage lockers, first aid kit, one (1) staff refrigerator/freezer, one (1) client all-gender restroom. In a separate unit, connected to Bldg. #1 consists of two (2) office rooms, kitchen, food preparation area, and one (1) staff refrigerator/freezer. Building #2: activity room, two (2) clients bathrooms, first aid kit, two (2) participants refrigerators/freezers. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and the following was inspected:
Physical Plant & Environment Safety:
  • The program site has a screening area located in the entrance gate.
  • Smoke detectors/carbon monoxide detectors are tested and observed to be operational.
  • The program site has fire pull alarms.
  • The program site is not equipped with a sprinkler system.
  • The program site maintained a 30-day supply of PPEs such as masks, gloves, hand sanitizers and gowns and kept in the bath tub in one of the office's bathroom.
  • There are thirty six (36) lockers available for clients use in each building.
  • The program site provides TV/media and computers for clients' use.
  • Cleaning supplies and other toxic materials were stored and kept locked in a shed located in the side yard.
  • Hot water temperature was measured in the kitchen and two (2) bathrooms. Hot water read at 103.1 deg F in the kitchen, 103.8 deg F in bathroom #2 and 98.2 deg F in bathroom #3, (Bldg. 2) which were not within the required 105-120 degrees F. Bathrooms have hand air dryers, but LPA did not observe hand soaps and paper towels in some of the bathrooms. Program Director stated that those items are available upon request only for safety reasons as some clients eat them.
  • Five (5) fire extinguishers were observed in the kitchen, Buildings #1 & 2 and outside the buildings. Fire extinguishers were fully charged and serviced on August 24, 2022.
  • Doors, exits, hallways, and passageways were clear and free of obstruction. However, there were some unused/bulk items that were not cleared in the side yard.
  • The front yard/parking area was observed to be clean and free of debris.
  • No pools or bodies of water were observed in or around the building.
  • There are no firearms present at the facility.
  • The program site has a video camera monitor system inside and outside the building.

***CONTINUED ON LIC 809-C*****
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: QUALITY OF LIFE ACADEMY
FACILITY NUMBER: 198601740
VISIT DATE: 07/11/2023
NARRATIVE
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Operational Requirements:
  • A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan.
  • Fire & Earthquake Drill was last conducted on June 14, 2023. Program Director stated that they conduct the training on a monthly basis.
  • Liability Insurance is valid in the amount of $3,000,000.00 (aggregate limit) and $1,000,000.00 (each incident limit) and will expire on 7/30/2023.
  • The program provides (4) four computers for clients use.
  • The program site does not handle clients' cash resources.
  • One (1) main operating telephone line, with seven (7) units were observed and are easily accessible and available for clients' use.
Personnel Records-Training:
  • Criminal Record clearances/exemptions are maintained at the program site.
  • Client files were inspected and emergency contact information and health screenings were updated.
  • Staff files were inspected and contained required criminal record background checks, health screenings, TB test, and First-Aid/CPR.
Client Rights-Information:
  • The program site has adequate furnishings and equipment to meet the clients' needs.
  • Visitors policy was observed posted in the office area. Facility's protocol is that the visitors must come in the office first.
Food Service:
  • This day program serve meals, breakfast, lunch and snacks.
  • Food storage and preparation areas, which include pantries, cupboards, drawers and counters were observed to be clean and appropriate for food preparation. Appliances such as a microwave, refrigerator and stove were observed to be operating properly.
  • LPA observed one (1) staff cooking and two (2) knives were on the food preparation area. When the staff stepped away, she did not secure one of the knives and left it on the counter. LPA observed that other knives/sharp objects along with medications were observed to be in a locked cabinet in the kitchen.
  • The refrigerator was observed to be at 45 degrees Fahrenheit and the freezer at 0 degrees Fahrenheit.
Health Related Services:
  • First Aid supplies were observed in buildings 1 & 2, but both kits did not include all required supplies, such as topical antibiotics.
  • List of emergency contacts such as Police, Fire Dept. or paramedic unit was reviewed. The program site has one medical resource available to be called at all times.
  • Medications was observed stored and locked in the kitchen cabinet.
Disaster Preparedness:
  • The facility has a complete Emergency and Disaster Preparedness Plan that includes, EVAC Procedures, Transportation arrangements, Location of all utility shut-off valves and instructions for use.
  • The program has a contact information list of local emergency response personnel, clients authorized representative or local emergency contact name.

Pursuant to Title 22, deficiencies were cited on the attached 809D and Technical Assistance were issued. Exit interview conducted and a copy of this report was provided to the Program Director, Joshua Corzantes.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 07/11/2023 01:50 PM - It Cannot Be Edited


Created By: Bennette Pena On 07/11/2023 at 01:28 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: QUALITY OF LIFE ACADEMY
FACILITY NUMBER: 198601740

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, the licensee did not comply with the section cited above in which Bathroom #2 in Bldg. #2 has broken light and faucet. Some light switch plates are missing and chipped paints on the walls in both Buildings 1 &2 which poses/posed a potential health, safety or personal rights risk to clients in care.
POC Due Date: 07/25/2023
Plan of Correction
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Program Director will submit service report of the Maintenance personnel along with receipts and photos to CCL/LPA by POC due date.
Type B
Section Cited
CCR
82087(c)
Buildings and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, the licensee did not comply with the section cited above in which the side yard contained unused/bulk items that were not cleared in the side yard which poses/posed a potential health, safety or personal rights risk to clients in care.
POC Due Date: 07/25/2023
Plan of Correction
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Program Director will clean and clear out the unusud/bulk items in the side yard and submit photos to CCL/LPA by POC due date.
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:David Sicairos
LICENSING EVALUATOR NAME:Bennette Pena
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 07/11/2023 01:50 PM - It Cannot Be Edited


Created By: Bennette Pena On 07/11/2023 at 01:28 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: QUALITY OF LIFE ACADEMY
FACILITY NUMBER: 198601740

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that hot water tempherature was measured in the kitchen and two (2) bathrooms. Hot water read at 103.1 deg F in the kitchen, 103.8 deg F in bathroom #2 and 98.2 deg F in bathroom #3, (Bldg. 2) which were not within the required 105-120 degrees F.which poses/posed a potential health, safety or personal rights risk to clients in care.
POC Due Date: 07/25/2023
Plan of Correction
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Program Director will submit a 7-day log of hot water temperature, tested 2x/day starting tomorrow, 7/12/2023 and submit the hot water temp. log to CCL/LPA by POC due date.
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:David Sicairos
LICENSING EVALUATOR NAME:Bennette Pena
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023


LIC809 (FAS) - (06/04)
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