198602143-9-13-2022-11-AS-ASOO-CJ8LLX-20220913085151

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602143
Report Date: 09/12/2022
Date Signed: 09/13/2022 08:52:05 AM

Document Has Been Signed on 09/13/2022 08:52 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	VISTAS - HAWTHORNE		FACILITY NUMBER:	198602143
ADMINISTRATOR:	MCKENNA, KELLY		FACILITY TYPE:	775
ADDRESS:	4679 W. EL SEGUNDO BLVD.		TELEPHONE:	(310) 675-5995
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY: 40		CENSUS: 20	DATE:	09/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Kelly McKenna, Administrator		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual inspection visit and infection control inspection to the above facility. LPA was met by Kelly McKenna, Administrator and the purpose of today’s visit was explained. There are currently (5) Westside Regional Centers consumers in placement. 5 ambulatory. The Day Program does have 5 clients physically at the facility and (4) participate virtually through zoom meetings. Facility alternates in-person clients. Some clients come in-person Monday and Wednesday and some clients come in person Tuesday and Thursday. On Fridays all clients participate virtually through zoom meetings. The facility is a commercial one story structure located in a commercial district. The facility is part of a church and it is constructed like a U shape. It consists of the following: administrators office, conference/quite room, storage closet (toxins-first aid), 2 restrooms, kitchen, main activity room with divider (zoom meeting room), covered middle patio with chairs and tables. LPA and Administrator toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. The (2) bathrooms are clean and operational. 1 client file was current and 1 staff was current. Smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are not kept in the facility. Facility does not provide food for clients, clients bring their own lunch. A comfortable temperature is maintained in the facility. Water temperature is between 118.7 degrees. linens are adequate, hazardous toxins and/or items are inaccessible to clients, 4 fire extinguishers are fully charged. Exit, walkways and/or passageways, are free of debris and/or hazards. The facility is in good repair.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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
MONTEREY PARK, CA 91754

FACILITY NAME: VISTAS - HAWTHORNE	FACILITY NUMBER: 198602143
	VISIT DATE: 09/12/2022

NARRATIVE

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During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in administrator office. LPA observed staff wearing masks, conference/quite room will be converted to isolation room(if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing N95 not completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & IPAD for clients to use, clients temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

Technical Advisory (TA) issued:

1. No fit testing for N95 completed for staff.

An exit interview conducted with Kelly McKenna, Administrator.

Due to technical difficulties (printer not working) copy of reports provided via email.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC809 (FAS) - (06/04)

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