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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602175
Report Date: 11/21/2024
Date Signed: 11/22/2024 10:16:23 AM

Document Has Been Signed on 11/22/2024 10:16 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:CROSSROADS COMMUNITY SERVICESFACILITY NUMBER:
198602175
ADMINISTRATOR/
DIRECTOR:		WHITING, CHERYL AFACILITY TYPE:
775
ADDRESS:105 W WALNUT STTELEPHONE:
(310) 523-5115
CITY:CARSONSTATE: CAZIP CODE:
90248
CAPACITY: 16CENSUS: 14DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Cheryl Whiting, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 11/21/24, 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 (16) ambulatory clients.

This day program is a single-story structure located in a commercial building. Facility grounds consists of, Lobby, front entrance with waiting area, (1) Director’s office, (1) conference Room, (2) bathrooms, (1) staff lounge and a large activity room.

LPA Shirley reviewed 5 client files, and 5 staff files and all had required documents.

LPA Shirley and Cheryl 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. The water delivered at 117.1 F.

Three (3) fire extinguishers were observed to be fully charged.

No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a hard copy of this report was provided to Cheryl Whiting.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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