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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601864
Report Date: 12/20/2023
Date Signed: 12/20/2023 12:25:19 PM

Document Has Been Signed on 12/20/2023 12:25 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 ASC, 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: 15DATE:
12/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Day Services Manager Christine GrantTIME COMPLETED:
12:45 PM
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On 12/20/2023 at 9:02 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Area Director Lisa Marie McDonald. LPA explained the purpose of the visit and were accompanied by McDonald inside the facility during this inspection. Day Services Manager Christine Grant joined us 20 minutes later.

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.

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 consumers.

LPA and McDonald toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected and had adequate lighting and furnishings. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 115.3 F.



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. Fire extinguishers were fully charged, and smoke detectors and carbon monoxide were operable. The day program has a working landline phone. The last fire drill was conducted 12/06/23. First aid kit is fully stocked with manual.

Continue to LIC 809-C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: DUNGARVIN CALIFORNIA - LONG BEACH
FACILITY NUMBER: 198601864
VISIT DATE: 12/20/2023
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There are no clients in care who are currently taking medication on-site. Documents are posted as mandated.

Five (5) staff records were reviewed, 5 out of 5 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. Three staff members were interviewed.

Five (5) client records were reviewed and, 5 out of 5 client records had Medical Assessments, IPPs and/or Needs & Services Plans. Three clients were interviewed.

No deficiencies are being cited.

An exit interview was conducted and technical assistance provided. A copy of this report was discussed and left with Christine Grant.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC809 (FAS) - (06/04)
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