<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601864
Report Date: 11/08/2024
Date Signed: 11/08/2024 11:00:04 AM

Document Has Been Signed on 11/08/2024 11:00 AM - 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:DUNGARVIN CALIFORNIA - LONG BEACHFACILITY NUMBER:
198601864
ADMINISTRATOR/
DIRECTOR:
LISA MARIE MCDONALDFACILITY TYPE:
775
ADDRESS:2534 E SOUTH STTELEPHONE:
(562) 408-4801
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 30CENSUS: 45DATE:
11/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Area Director Juan ZepedaTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/08/24, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Area Director Juan Zepeda as the purpose of the visit was explained. The facility is licensed for a capacity of 30 adults of which 10 may be non-ambulatory. Current census for the AM session is 27, and census for PM session is 18. Day program consumers are linked to the Harbor Regional center, the staff to consumer ratio is (1) staff to (3) consumers. Facility fees are current.

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, storage space for consumers to utilize, laundry area, and (4) designated restrooms with toilets and sinks are operable. A private shower is included in the rear of the restroom. Consumers bring their own meals and program provides snacks only. All rooms were inspected and had adequate lighting and furnishings. Bathrooms were found to be within Title 22 regulations and were clean and operational. There were no bodies of water or obstructions on the premises. Toxins and sharps were stored and inaccessible 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 and had internet service. The last fire drill was conducted 11/07/24, LBFD completed a fire inspection on 08/08/24. First aid kit is fully stocked with manual.

LPA conducted a review of (5) consumer records, and (3) staff records, no discrepancies observed.

Technical violations given,and deficiency cited on 809D page.

Exit interview conducted, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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
Document Has Been Signed on 11/08/2024 11:00 AM - It Cannot Be Edited


Created By: Lizeth Villegas On 11/08/2024 at 10:45 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: DUNGARVIN CALIFORNIA - LONG BEACH

FACILITY NUMBER: 198601864

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 11/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82075(g)(1)(A-H)
82-75 Health related services
(g) If the day program has no medical unit at the program site, first aid supplies shall be maintained and be readily available in a central location.

(1) The supplies shall include at least the following:

(A) A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or
federal health agency.

(B) Sterile first aid dressings.

(C) Bandages or roller bandages.

(D) Adhesive tape.

(E) Scissors.

(F) Tweezers.

(G) Thermometers.

(H) Antiseptic solution.
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the facility does not have a current first aid manual on site which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2024
Plan of Correction
1
2
3
4
Licensee/program director will purchase new first aid kit and manual and will submit proof of purchase to LPA by POC due date. Lizeth.villegas@dss.ca.gov
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2