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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601949
Report Date: 11/17/2023
Date Signed: 11/17/2023 02:44:49 PM

Document Has Been Signed on 11/17/2023 02:44 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:OPARC SUMMIT SERVICES WESTFACILITY NUMBER:
198601949
ADMINISTRATOR:TOMINES, JONATHANFACILITY TYPE:
775
ADDRESS:355 S LEMON AVE STE GTELEPHONE:
(909) 598-8055
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY: 60CENSUS: 34DATE:
11/17/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Stephen Falla, Program ManagerTIME COMPLETED:
02:55 PM
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
Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the annual inspect. LPA met with Director of day programs, Kathlene Parker, and explained the purpose of the visit.

During the visit today, LPA reviewed staff files, client files, and medication.

LPA selected 4 Staff files to review. Staff are fingerprint cleared and associated to the facility. Each of the files consist of the Personnel Record, Health Screening form with TB test result, and current CPR and First Aid certificate. Staff have continuous training throughout the year and are documented. Staff have current CPI training as well.
LPA selected 5 Client files for review. Each client file has the Admission Agreement, Personal Rights form, Consent forms, medical assessment with TB test result, Individual Program Plan from Regional Center, and the day program's semi-annual progress report.
There is currently one client taking medication at the day program. The medication is kept in a locked bag that requires a key to open. Staff properly indicates the date and time in which the medication is given.
Per the director, staff have CPI certification and would only use any type of restraint as a last resort. They have not had to utilize any restraints in the recent months but is aware that if any manual restraint is used, it shall be reported to licensing no later than the next business day.

There are no deficiencies issued today. An exit interview was held and a copy of this report was given to Director Parker.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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 1