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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601990
Report Date: 02/18/2022
Date Signed: 02/18/2022 11:52:29 PM

Document Has Been Signed on 02/18/2022 11:52 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DUNGARVIN CALIFORNIA - NORWALKFACILITY NUMBER:
198601990
ADMINISTRATOR:CHRISTINE GRANTFACILITY TYPE:
775
ADDRESS:11005 FIRESTONE BLVD UNIT 117TELEPHONE:
(562) 623-9800
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 30CENSUS: 2DATE:
02/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Christine GrantTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Day Services Manager Christine Grant and explained the purpose for todays visit. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections with Program Director Ariel Elizarraras. The facility phone number is 562 623 9800.

The first session takes place from 8am to 12pm. The second session takes place from 1pm to 5pm. Neither sessions go above the licensed capacity of 30 clients. The staff to client ratio is 1:3.

This program consists of the following:
Administrative Offices, Garden Room, Library, Exercise Room, Sensory Room/Quiet Room, Music Room, Game Room, Emergency Supply Room, Kitchen, Art Room, Computer Room and 4 restrooms.

During the visit the Infection control domain was used and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, and throughout the facility. Hand sanitizing gel and masks were located at the entry of each room. A Pre screening area with PPE supplies was observed upon entry into the facility. The facility mitigation plan was reviewed and approved on 03/22/2021.

LPA conducted a complete tour of the facility, consumers bring their own lunch/snacks, and the facility has back up food if a consumer may forget to bring their lunch/snack. There is no medication administered during both sessions. There are a total of 4 fully charged fire extinguishers throughout the facility. The fire alarm system is hardwired/pull switch. carbon monoxide detector is operable. The water temperature was tested and measured 120 degrees F.

There were no deficiencies cited. Exit interview conducted.
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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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