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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602175
Report Date: 11/08/2023
Date Signed: 11/08/2023 02:28:20 PM

Document Has Been Signed on 11/08/2023 02:28 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:CROSSROADS COMMUNITY SERVICESFACILITY NUMBER:
198602175
ADMINISTRATOR:WHITING, CHERYL AFACILITY TYPE:
775
ADDRESS:105 W WALNUT STTELEPHONE:
(310) 523-5115
CITY:CARSONSTATE: CAZIP CODE:
90248
CAPACITY: 16CENSUS: 7DATE:
11/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Michelle Wright, CoordinatorTIME COMPLETED:
03:30 PM
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On 11/8/23, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA met with Executive Director Cheryl Whiting and explained the purpose of today’s visit. The facility is licensed for sixteen ambulatory clients.

The day program is a single-story structure located in a commercial building. Facility grounds consist of the following: Lobby, front entrance with waiting area, director's office, 1 conference room, 2 restrooms 1 male and 1 female, staff lounge and a large activity room.

Common areas such as bathrooms and activity rooms were observed to be neat, clean, and properly furnished.

LPA Shirley and Program Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. Bathrooms were found to be within Title 22 regulations and were clean and operational.

LPA Shirley observed the facility to be sanitary and appropriately furnished at the time of visit. Cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. Fire extinguishers are fully charged.


No deficiencies were cited during this inspection visit. A copy of this report was signed and left with Administrator Cheryl Whiting.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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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