<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602143
Report Date: 10/02/2024
Date Signed: 10/02/2024 12:21:50 PM

Document Has Been Signed on 10/02/2024 12:21 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:VISTAS - HAWTHORNEFACILITY NUMBER:
198602143
ADMINISTRATOR/
DIRECTOR:		MCKENNA, KELLYFACILITY TYPE:
775
ADDRESS:4679 W. EL SEGUNDO BLVD.TELEPHONE:
(310) 675-5995
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 40CENSUS: 14DATE:
10/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Administrator - Kelly McKennaTIME VISIT/
INSPECTION COMPLETED:
12:40 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
On 10/02/2024 at around 9:20 AM, Licensing Program Analyst (LPA) Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with the Administrator Kelly McKenna. LPA explained the purpose of the visit and was accompanied by Administrator inside and outside the facility during this inspection.

This facility is licensed to serve 40 adults ages 18 – 59 years, of which 5 maybe non-ambulatory.

A total of 14 ambulatory clients are currently enrolled in this facility.

The Annual Licensing Fees are current.

The facility is a one-story building located on a main street. The facility consist of 2 offices, 1 quiet room, 1 storage room, 1 women’s bathroom, 1 men’s bathroom, 1 kitchen, 1 classroom, 1 outside courtyard with shaded seating.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: VISTAS - HAWTHORNE
FACILITY NUMBER: 198602143
VISIT DATE: 10/02/2024
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
26
27
28
29
30
31
32
Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to clients. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

Documents are posted as mandated. LPA toured kitchen and knives and toxins were locked. Last Fire drill was conducted on 09/12/2024. First aid kit is fully stocked with manual. Fire Clearance was Granted on 03/21/2024 by the County of Los Angeles Fire Department. The facility had a Fire Alarm Testing and Fire Station Testing on 10/27/2023 and no defects were cited. There are several fire extinguishers in the facility and they were last serviced on 04/03/2024. Bathroom toilets and water faucets worked properly. Adequate lighting and toiletries accessible to clients. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit.

4 staff records were reviewed, 4 out of 4 staff records had required documentation.
5 client records were reviewed and, 5 out of 5 client records had required documentation.

No deficiencies are being cited based on LPA observation and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted and a copy of this report was left with the Administrator.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2