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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601864
Report Date: 09/26/2022
Date Signed: 09/26/2022 12:09:37 PM

Document Has Been Signed on 09/26/2022 12:09 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:DUNGARVIN CALIFORNIA - LONG BEACHFACILITY NUMBER:
198601864
ADMINISTRATOR:GORDON DAMEONFACILITY TYPE:
775
ADDRESS:2534 E SOUTH STTELEPHONE:
(562) 408-4801
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 30CENSUS: 3DATE:
09/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:TIME COMPLETED:
12:19 PM
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On 09/26/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA met with Program Director Rian Phillips and Area Director Anthony Mac Connell and explained the purpose of today’s visit. The day program is licensed to operate for thirty (30) ambulatory of which ten (10) may be non-ambulatory adults. The clients are Harbor Regional Center and South-Central Los Angeles Regional Center consumers.

The day program is a single-story structure located in a commercial neighborhood. It consists of the following: administrative offices, activity room, music room, salon/spa room, physical activity room, arts and crafts room, isolation/library room, computer lab area, break room/kitchen area, laundry area, and (4) designated restrooms with toilets and sinks are operable. A private shower is included in the rear of the restroom.

LPA and program director toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected and had adequate lighting furnishings. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 106.6 – 109.4 F. A comfortable temperature of 73 degrees was maintained.

LPA observed the day program to be sanitary and appropriately supplied at the time of the visit. Storage rooms for cleaning supplies, and toxins, were stored and not accessible to consumers. The kitchen was inspected and found all appliances in working condition. Fire extinguishers were fully charged, and smoke detectors and carbon monoxide were operable. The day program has several working landline phones all working properly. The last disaster drill was conducted 09/08/22 and is documented for both AM and PM sessions.


Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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: DUNGARVIN CALIFORNIA - LONG BEACH
FACILITY NUMBER: 198601864
VISIT DATE: 09/26/2022
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INFECTION CONTROL:
During this visit, LPA observed the day program's infection control practices. LPA observed screening protocols for visitors, staff, and consumers, and sanitizing stations in common areas and restrooms. LPA observed staff and consumers were wearing face coverings, and LPA observed the facility had a sufficient supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of staff COVID-19 vaccination and N-95 Fit Tests were maintained in order, accurate, and complete. The day program has an approved Mitigation Plan with CCLD and has submitted an Infection Control Plan for 2022.

No deficiencies were observed during today's visit.

An exit interview was conducted, and a copy of this report was given to the Program Director.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC809 (FAS) - (06/04)
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