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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601740
Report Date: 05/21/2024
Date Signed: 05/21/2024 12:51:47 PM

Document Has Been Signed on 05/21/2024 12:51 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:QUALITY OF LIFE ACADEMYFACILITY NUMBER:
198601740
ADMINISTRATOR/
DIRECTOR:		NNAEMEKA EZENAGUFACILITY TYPE:
775
ADDRESS:8439 CALIFORNIA AVENUETELEPHONE:
(562) 372-4750
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY: 66CENSUS: 55DATE:
05/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:staff Michelle CardonaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Tyler Reyes and Jose Villalobos conducted an unannounced required annual inspection using the CARE tools. LPAs met with staff Michelle Cardona and explained the reason of the visit.

The facility is an Adult Day Program (ADP) licensed to serve clients age range 18 and above, 66 ambulatory only and vendor by South Central Regional Center. The program consists of consists of 2 single-story buildings within the city of South Gate.

Infection Control: LPA observed the facility has sufficient PPE supplies. Infection Control Plan is in place. The plan was collected and reviewed.

Physical Plant and Environmental Safety: 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 (1) participants refrigerators/freezers.

Operational Requirements: Facility is operating within its approved clearance.

Staffing: The facility has a sufficient staffing in place to meet Staff-Client Ratio.


Continued on LIC 809-C
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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: 05/21/2024
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Personnel Records-Training: Personal records centrally stored. LPA inspected five (5) staff files. All staff are fingerprint cleared.

Client's Right - Information: No, postural support documentation observed. Required postings observed.

Food Service: Pesticides and other toxic substances were not stored with the food supply. Kitchen area was clean.

Client Records/Incident Reports: Client files are centrally stored. LPA reviewed four (5) client files. Client files are up to date and have required documents.

Health Related Services: LPA reviewed (3) clients medication.

Incidental Medical Services: There are no clients in care with prohibited or restricted health conditions. First Aid kid observed and available when needed.

Disaster preparedness: The facility is currently using the old LIC 610D Emergency Disaster Plan . The plan was reviewed. Facility has client information readily available in case of emergencies.

Emergency Intervention: The facility are not using any restraints in the facility.



Per Title 22 Regulations, no deficiencies are being cited but a Technical Violation was given on today's visit.


Exit Interview conducted. A copy of the LIC 809 and Technical Violations was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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