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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602143
Report Date: 11/17/2023
Date Signed: 11/17/2023 12:43:52 PM

Document Has Been Signed on 11/17/2023 12:43 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:VISTAS - HAWTHORNEFACILITY NUMBER:
198602143
ADMINISTRATOR:MCKENNA, KELLYFACILITY TYPE:
775
ADDRESS:4679 W. EL SEGUNDO BLVD.TELEPHONE:
(310) 675-5995
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 40CENSUS: 10DATE:
11/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:59 AM
MET WITH:Kelly Mckenna-DirectorTIME COMPLETED:
12:43 PM
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On 11/17/2023, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Kelly Mckenna-Director. The facility profile shows that the facility is licensed for a capacity of (40) clients, of which (5) may be non-Ambulatory. The director stated that the facility has (10) clients enrolled in the program. The total number of non-ambulatory clients attending the program is (10). The staff-to-client ratio is (1) staff to (3) clients. Director stated that the facility has (0) clients with a Restricted Health Care condition. Currently, there are (3) clients using protective or assisted devices. The facility conducted a fire drill on 11/6/2023, and a Disaster Plan was on file. The last inspection held by the fire department was on 10/27/2023. The program does not provide transportation.

LPA Iniguez and Director toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. The (2) bathrooms are clean 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.

As a part of today's inspection, LPA reviewed (4) client records, (3) staff records, and medications and inspected the entire facility inside and out. LPA and Director toured the entire facility. All records were maintained properly.


Evaluation Report continues LIC 809-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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: VISTAS - HAWTHORNE
FACILITY NUMBER: 198602143
VISIT DATE: 11/17/2023
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Inside areas are free of hazards and obstructions. (2) restrooms have working toilets and wash basins. They will accommodate non-ambulatory clients in a wheelchair. Emergency Phone Numbers are Posted & readily available for review in the activity area. Fire Extinguishers are up to fire code. The facilities telephone system is working correctly.
Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature properly measure between 105F° and 120F°: bathroom #1 was 110.5°F, bathroom, #2 was 111.7°F and kitchen sink was 113.5°F . A comfortable temperature is maintained in the facility. Smoke detectors and carbon monoxide alarm system is build-in and checked by the fire department every year. The facility is equipped with central air. All knifes and poisons were kept locked at the time of visit.

A first aid kit has been inspected, with at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual, which are stored in locked steel drawers, available for staff use but inaccessible to clients.

The facility does not handle the cash resources of clients or manage clients’ medications.

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

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Director Kelly Mckenna.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC809 (FAS) - (06/04)
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