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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601767
Report Date: 08/04/2022
Date Signed: 08/04/2022 02:25:33 PM

Document Has Been Signed on 08/04/2022 02:25 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:COLE VOCATIONAL SERVICES SIGNAL HILLFACILITY NUMBER:
198601767
ADMINISTRATOR:PORTER, LASONJAFACILITY TYPE:
775
ADDRESS:2798 JUNIPERO AVETELEPHONE:
(562) 912-7340
CITY:SIGNAL HILLSTATE: CAZIP CODE:
90755
CAPACITY: 30CENSUS: 10DATE:
08/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:JasminTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Perry Scott and LPM Janae Hammond conducted an unannounced Annual Required inspection to the above Adult Day Program (ADP). Upon arriving at the facility LPA/LPM met with Program Supervisor Jasmin Cortes and informed her of the purpose of the visit. The facility is licensed to serve thirty (30) Developmentally Disabled clients, ages 18 - 59 years. (30) Non-Ambulatory. Staff to Client ratio is one (1) staff to three (3) clients.

LPA Perry Scott & LPM Janae Hammond and Program supervisor toured the entire physical plant inside and out. Facility consists of the following: Activity Room, Computer Room, Art Room, Gardening Room, Nurse Station, Style Room, Sensory Room, Changing Room, Kitchen, Storage and Administrative offices. The program hours are 8:00am to 12:00pm and from 1:00pm to 5:00 pm Monday through Friday. Clients bring their own lunches, however the facility has backup food to prepare for clients, if needed. Facility provides one snack per program session for all clients. There is a nurse on premises that gives clients medications as prescribed. LPA/LPM observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in the facility. Care and Supervision necessary to meet the client's needs and all services specified in the admission agreements are being met.

The last fire extinguisher service date was on 12/21/21. LPA observed the facility walls/ floors were in good condition, and there is adequate lighting throughout the facility. The fire extinguishers were properly charged, smoke and carbon monoxide detectors are operational. The program has ample storage space. The chemicals and sharp objects were properly stored/ locked. The men's and women's restrooms were clean and maintained in a safe and sanitary operating condition; and are sufficient for staff and clients and meet Title 22 regulations. The facilities kitchen appears to be clean and well maintained. The first aid kit was stocked with a manual and available for use. The facility walkways and exits throughout the ADP were clear of hazards and accessible to clients. The hot water temperature was measured and is within Title 22 Regulations (110F).
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: COLE VOCATIONAL SERVICES SIGNAL HILL
FACILITY NUMBER: 198601767
VISIT DATE: 08/04/2022
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Facility provides lockers to clients for their personal belongings. Facility staff ensure that clients are kept clean and dry, and that the day program facility remains free of odors. The program administration develops, maintains, and implements written plans for orientation and on-the-job training.

And finally, LPA/LPM observed the following to be in compliance: the facility's infection control practices; screening protocols for visitors, staff, and residents; sanitizing stations in common areas and restrooms; every staff was wearing a face covering; the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.

No deficiencies cited. Please note there is a new covid PIN. For adult day program guidance: PIN 22-23 ASC

Exit interview conducted and copy of Report provided to Program Supervisor Jasmin Cortes
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC809 (FAS) - (06/04)
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