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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602160
Report Date: 02/15/2024
Date Signed: 02/15/2024 11:47:28 AM

Document Has Been Signed on 02/15/2024 11:47 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:SVS LAKEWOOD EASTFACILITY NUMBER:
198602160
ADMINISTRATOR:RODRIGUEZ, ANGELAFACILITY TYPE:
775
ADDRESS:5720 BELLFLOWER BLVDTELEPHONE:
(562) 677-2093
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY: 21CENSUS: 46DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Marisa Juarez-Case ManagerTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Sanjay Vaid and Luis Mora conducted an unannounced annual visit at the facility using the CARE Tool. LPAs Vaid and Mora met with Case Manager Marisa Juarez and explained the reason for the visit.

The facility is an Adult Day Program (ADP) licensed to accommodate 21 ambulatory clients of which 6 may be non-ambulatory, in the age range of 18 and over. The program consists of 1 large single-story building. A tour of the single-story building included: reception area, conference room, 2 case managers offices, program directors’ office, 3 staff offices, travel office, leisure room, fitness room, kitchen, computer lab, quiet/relaxation room, locked storage cabinets, 2 storage rooms, janitor closet, copy room, style room, arts and crafts room, 4 restrooms, and a locker area.

LPAs toured the facility with Marisa Juarez and the following was observed: a total of 18 clients were at the facility during the visit. The staff to client ratio is 1:3. The program site is clean, safe, sanitary and in good repair. All passageways are free from obstruction. Disinfectants, cleaning solutions and poisons are inaccessible to clients and are locked inside a janitor’s closet. There are three fire extinguishers in total, located in the reception area, kitchen, and hallway. All 3 fire extinguishers are fully charged. Facility has a wired fire system throughout the facility. The restrooms are well maintained and in good repair. The water temperature was tested, and it measured at 105.3 degrees F, which is within the required 105-120 degrees F. The First Aid kit is kept in one of the case manager’s office and it is fully stocked with all required items including a current manual. Facility does not keep or administer medications. Food is not prepared at this program and clients are able to bring their own food. The kitchen area has a refrigerator where the clients can store their food. Sharps are kept locked in a kitchen cabinet. Five client and Five staff files were reviewed in today’s visit. The last fire/emergency drill was conducted 11/29/2023 and earthquake disaster drill were conducted on 10/19/2023. LPAs interviewed 3 clients and 3 staff.
Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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