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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602052
Report Date: 02/11/2022
Date Signed: 02/11/2022 09:23:47 PM

Document Has Been Signed on 02/11/2022 09:23 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 DR #100
MONTERY PARK, CA 91754
FACILITY NAME:SOUTH BAY VOCATIONAL CENTERFACILITY NUMBER:
198602052
ADMINISTRATOR:COREY SYLVEFACILITY TYPE:
775
ADDRESS:21915 FIGUEROA STREETTELEPHONE:
(310) 901-4969
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 32CENSUS: 15DATE:
02/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Alexa ArechigaTIME COMPLETED:
03:59 PM
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On 02/11/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with the program director Alexa Arechiga. LPA explained the purpose of today’s visit. The facility is licensed to operate for thirty-two (32) consumers of which four (4) may be non-ambulatory ages 18 through 59. The consumers are Harbor Regional Center and Westside Regional Center.

The property is located in a commercial area of Carson. Ms. Arechiga stated that there are currently eight (15) consumers enrolled. Ms. Arechiga stated that there was no medication administered at this time.

LPA along with the program director toured the facility. The facility consists of (2) activity rooms, (1) kitchen, (1) men's restroom, (1) women's restroom, (1) handicap restroom, and (2) staff offices. LPA observed the facility is clean, sanitary, and in good repair. The facility has smoke detectors that were tested and operable and (2) fire extinguishers were fully charged. LPA observed (1) carbon monoxide located in the hallway area. Toxins and sharp objects were locked and inaccessible to the consumer's the inside kitchen area.

The men's and women’s restrooms are clean and operable. The water temperature was tested and measured at 109.1 degrees Fahrenheit. The kitchen is clean and a refrigerator is available for consumers' use. Food items in the refrigerator and food storage are properly stored. The day program does not provide lunch however snacks are available to consumers. A first aid kit is available. Walkways throughout the day program are clear of hazards and all exits are clear of debris. The facility had all the mandated posters posted throughout the day program. The program has an Emergency Disaster Preparedness Plan. A Fire & Earthquake drills were conducted in January 2022.

Evaluation Report continues on LIC 809-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: SOUTH BAY VOCATIONAL CENTER
FACILITY NUMBER: 198602052
VISIT DATE: 02/11/2022
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During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and consumers, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The program has an approved Mitigation Plan filed with CCLD.

Advisory Notes - Technical Assistance was issued, please see LIC9102-AN.

No deficiencies were cited during this inspection visit.

An exit interview was conducted and a copy of this report was provided to Alexa Arechiga.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC809 (FAS) - (06/04)
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