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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602052
Report Date: 02/24/2023
Date Signed: 02/24/2023 11:06:33 AM

Document Has Been Signed on 02/24/2023 11:06 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SOUTH BAY VOCATIONAL CENTERFACILITY NUMBER:
198602052
ADMINISTRATOR:COREY SYLVEFACILITY TYPE:
775
ADDRESS:21915 FIGUEROA STREETTELEPHONE:
3109014969
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 32CENSUS: 25DATE:
02/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Alexa ArechigaTIME COMPLETED:
11:23 AM
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On 02/24/23, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual required visit with a primary focus on Infection Control measures. 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, South Central Los Angeles Regional Center and Westside Regional Center.

The property is located in a commercial area of Carson. Ms. Arechiga stated that there are currently twenty-five (25) consumers enrolled. Ms. Arechiga stated that there are medications administered at this time through herself and the Program Counselor, Heriberto (Eddie) Alonso.

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, yet needs repair in bathroom three (3). 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 inside kitchen area.

The men's and women’s restrooms are clean and operable. The water temperature was tested and measured at 119.4 F. The kitchen is clean and a refrigerator is available for consumers' and staff 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. The Fire & Earthquake drills were conducted in December 2022, with a recent fire inspection having been completed 12/9/2022.
See LIC809-C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTH BAY VOCATIONAL CENTER
FACILITY NUMBER: 198602052
VISIT DATE: 02/24/2023
NARRATIVE
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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.

During today's visit there was one (1) deficiency cited during this inspection visit, see LIC809-D.

An exit interview was conducted and a copy of this report and appeal rights were provided to Alexa Arechiga.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/24/2023 11:06 AM - It Cannot Be Edited


Created By: Mario Leon On 02/24/2023 at 10:30 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
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SOUTH BAY VOCATIONAL CENTER
FACILITY NUMBER: 198602052

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, the licensee did not comply with the section cited above in having a roof leak above bathroom number three (3) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/24/2023
Plan of Correction
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Program Director, Alexa Arechiga (PD1), and LPA Leon have agreed that PD1 will submit media evidence (photo/video) via email to MARIO.LEON@DSS.CA.GOV or ERNAND.DABUET@DSS.CA.GOV on or prior to the POC due date which is March third (3rd) 2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Ulysses Coronel
LICENSING EVALUATOR NAME:Mario Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2023


LIC809 (FAS) - (06/04)
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