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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601990
Report Date: 02/22/2024
Date Signed: 02/27/2024 08:30:39 AM

Document Has Been Signed on 02/27/2024 08:30 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
MONTEREY PARK ASC, 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: 20DATE:
02/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Ariel Elizarraras- Program DirectorTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPAs) Sanjay Vaid and Angelica Rea conducted an unannounced Required 1 year inspection at the facility and met with Program Director Ariel Elizarraras and explained the purpose for today’s visit.
During today's visit LPAs Vaid and Rea conducted a tour of the physical plant with Ariel.

This program physical plant consists of the following:
Three Administrative Offices, Garden Room (Activity), Library, Exercise Room, Spa Room/Quiet Room, Music Room, Game Room, Emergency Supply Room, Janitor Room, Kitchen, Art Room, Computer Room and 4 restrooms (1 contains laundry machines). The ratio is 1:3. LPAs observed the kitchen, client’s bring their own snacks, the facility has food for cooking classes, and emergency food supplies available. Sharps are locked in kitchen and art room cabinets maintained locked. There is no medication administered to clients at this time. Chemicals locked in the Janitor Room. There are a total of 4 fully charged fire extinguishers throughout the facility. The fire alarm system and carbon monoxides are hardwired and connected to the Norwalk Fire Department The water temperature was tested and measured and falls between Title 22 Regulations. Activity Calendar posted, facility has 3 operable transportation vehicles, two are in the community, one vehicle is at facility and was inspected. Restrooms stocked and cleaned pathways and hallways clean and free of obstructions. LPAs reviewed 3 staff files and 3 client files were reviewed, interviews were not conducted due to clients functioning level. The facility had all COVID postings at the front entrance, bathrooms, and throughout the facility. Hand sanitizing gel and masks were located at the entry of each room. The facility mitigation plan was reviewed and approved on 03/22/2021. Trash bins with lids were observed. Fire drill was conducted 01/02/2024 and earthquake drill was conducted on 01/10/2024.

There were no deficiencies cited. An exit interview conducted with Program Director Ariel Elizarraras.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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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