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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601767
Report Date: 02/23/2024
Date Signed: 02/23/2024 12:54:30 PM

Document Has Been Signed on 02/23/2024 12:54 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
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: 45DATE:
02/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director Aniece J. JohnsonTIME COMPLETED:
01:00 PM
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On 02/23/24 Licensing program analyst (LPA) Villegas conducted an unannounced case management visit to follow up on incident that occurred on 2/12/24 and was reported to the department. LPA met with Director Aniece J. Johnson as the purpose of todays visit was explained.

The case management visit consisted of the following: On 02/23/24 LPA obtained copies of the staff and client rosters, the following copies for C1; facesheet, Harbor regional center IPP dated 06/23/23, action plan summary, and communication logs dated; 07/25/23, 07/28/23, 02/07/24, 02/21/24, and 02/22/24. On 02/23/24 LPA obtained the following copies for S1; ID card,DSP job summary, employee rights, zero tolerance of abuse policy, statement acknowledging requirement to report suspected
abuse of dependent adults and elders, requirements for reporting suspected abuse or neglect acknowledgement, New employee orientation (Day1-4 training), and records of discussion dated 10/17/23, communication regarding code of conduct and use of profanity in the workplace, and a copy of previous SIR investigation dated 05/31/24. On 02/23/24 LPA interviewed Director (D1), Staff #2-5 (S2-S5), Witness #1-2 (W1-W2), and client #2 (C2). LPA was unable to interview S1, LPA left a detailed voicemail with call back information. As part of a health and safety check LPA conducted a tour of the facility, there were no immediate health and safety concerns.

Due to insufficient information available at this time, the incident need(s) further investigation.
Exit interview conducted with Director Aniece J. Johnson, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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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