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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602052
Report Date: 12/20/2024
Date Signed: 12/20/2024 03:12:05 PM

Document Has Been Signed on 12/20/2024 03:12 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:SOUTH BAY VOCATIONAL CENTERFACILITY NUMBER:
198602052
ADMINISTRATOR/
DIRECTOR:		COREY SYLVEFACILITY TYPE:
775
ADDRESS:21915 FIGUEROA STREETTELEPHONE:
(310) 901-4969
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 32CENSUS: 20DATE:
12/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Alexa Arechiga TIME VISIT/
INSPECTION COMPLETED:
12:17 PM
NARRATIVE
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On 12/20/24, 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 and Eddie Alonso. 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 (20) consumers enrolled. Ms. Arechiga stated no are currently no clients required prescribed medications or PRN assistance.

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 112.4 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 2023.

(Evaluation Report continues LIC 809-C)
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SOUTH BAY VOCATIONAL CENTER
FACILITY NUMBER: 198602052
VISIT DATE: 12/20/2024
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 the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

During the visit, a review/audit of (4) client's and (4) staff files. The day program is current on annual licensing has an open balance of $303.00 due by 01/10/25. Invoice information was provided to Alexa Arechiga. The program has a certificate of liability insurance policy #CCP-1273893 effective: 11/20/24 - 11/20/25.

There were two (2) deficiencies cited during this inspection visit when review/audit of personnel records. (see LIC809-D)
  • Client #1 and Client #3 did not have current medical assessment on file.
  • Client #1 and Client #3 did not have results for Tuberculosis (TB) examination.
  • Staff #2 did not have current First Aid/CPR on file.
  • Staff #2 did not have results for Tuberculosis (TB) examination.

Based on interviews, observation, and record reviews the licensee violated the California Code Regulations (CCR) of Title 22, Division 6, Chapter 3,

Deficiencies are issued and an exit interview is conducted with Alexa Arechiga. Appeal rights and a copy of the report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 12/20/2024 03:12 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 12/20/2024 at 11:33 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SOUTH BAY VOCATIONAL CENTER
FACILITY NUMBER: 198602052

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82065(g)(1)
Personnel Requirements
(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. LPA identified staff #2 did not have a test results on file. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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Licensee will ensure that all employees have a TB test result on file. Licensee will have a TB test for staff #2 by POC due date 01/10/25.
Type B
Section Cited
CCR
82068.2(f)(1)(B)
Needs and Services Plan
(f) The completed Needs and Services Plan shall include: (1) The client's desires and background and formal supports, obtained from the client's family or his/her authorized representative, if any, regarding the following: (B) A written medical assessment including primary physician, health problems and medical history, prescribed medications and their strength, quantity, frequency required and purpose as specified in Section 82069(b)(3).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above. LPA identified client #1&#3 did not have medical assessment on file. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/20/2025
Plan of Correction
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Licensee must adhere to Title 22 82068.2 Regulation and ensure that all clients have medical assessment on file. Licensee will obtain medicall assessment for client #1 & #3 by POC due date 01/20/25.
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:Janae Hammond
LICENSING EVALUATOR NAME:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 12/20/2024 03:12 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 12/20/2024 at 11:34 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SOUTH BAY VOCATIONAL CENTER
FACILITY NUMBER: 198602052

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82069(b)(1)
Client Medical Assessments
(b) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. LPA identified client #1&#3 did not have TB test results on file. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/20/2025
Plan of Correction
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Licensee will ensure to adhere to Title 22 82069 Regulations and ensure that all clients prior to admittance have TB test results on file. Licensee will obtain TB test results for client #1 & #3 by POC due date 01/20/25.
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:Janae Hammond
LICENSING EVALUATOR NAME:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2024


LIC809 (FAS) - (06/04)
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