198602577-12-20-2023-11-AS-SLEO-CYPUU8-20231220145307

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602577
Report Date: 12/20/2023
Date Signed: 12/20/2023 02:53:25 PM

Document Has Been Signed on 12/20/2023 02:53 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:	CALIFORNIA EMPLOYMENT DEV & SUPPORT SERVICES INC		FACILITY NUMBER:	198602577
ADMINISTRATOR:	ENUNWA, JOHN		FACILITY TYPE:	775
ADDRESS:	14127-14127 1/2 CRENSHAW BLVD		TELEPHONE:	(310) 617-5912
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY: 30		CENSUS: 30	DATE:	12/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Trinece Levias - Program Administrator		TIME COMPLETED:	03:30 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 12/20/2023 at around 9:25 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with the Program Administrator Trinece Levias. 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 30 adults ages 18 and over, of which 5 may be non-ambulatory clients. A total of 30 clients are currently registered in this facility. Today there were 21 clients at the facility. The Annual Licensing Fees are current. The facility is a one story building located in a business center. The facility consists of 3 large rooms. The first room is the reception area which consist of the main entrance, 1 locker room, and 1 small kitchen. The second room is the gathering room which consists of a large tv, games, 1 bathroom, and 1 office room. The third room is the conference room which consists of several file cabinets, 3 desks, 1 office room, and 1 quiet room. LPA toured the kitchen area and observed knives and toxins in a locked storage cabinet.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CALIFORNIA EMPLOYMENT DEV & SUPPORT SERVICES INC	FACILITY NUMBER: 198602577
	VISIT DATE: 12/20/2023

NARRATIVE

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Documents are posted as mandated. Last Fire drill was conducted on 12/4/2023. The County of Los Angeles Fire Department Fire Prevention Division completed the Official Inspection on 03/24/2023 and the facility was granted fire clearance. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. There are several fire extinguishers around the facility, and they were last serviced on 07/23/2023.

Bathrooms include accessible toiletries to clients and staff. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit.

6 staff records were reviewed, 6 out of 6 staff records had current Criminal Record Clearances, Job Applications, Facility Trainings/Drills, and signed Employee Rights. 1 out of 6 staff records did not have a Tuberculosis Test.

5 client records were reviewed and, 5 out of 5 client records had Admission Agreements, Medical Assessments, Consent Forms, Weight Record, Emergency Information, Appraisal & Needs Service Plan, and Personal Rights. 1 out of 5 records did not have a Tuberculosis Test.

Deficiencies are being cited based on LPA's record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding Tuberculosis Test.

An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/20/2023 02:53 PM - It Cannot Be Edited

Created By: Socorro Leandro On 12/20/2023 at 02:23 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CALIFORNIA EMPLOYMENT DEV & SUPPORT SERVICES INC	FACILITY NUMBER: 198602577
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82065(g)(1)

Personnel Requirements

(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 6 staff records did not have a negative tuberculosis test, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/16/2024
	Plan of Correction
1 2 3 4	Licenssee will email Staff 5's negative tuburculosis test to Socorro.Leandro@dss.ca.gov.

Type B

Section Cited

CCR

82069(b)(1)

Client Medical Assessments

(b) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 5 client records did not have a negative tuberculosis test, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/16/2024
	Plan of Correction
1 2 3 4	Licensee will email Client's 4's negative tuburculosis test to Socorro.Leandro@dss.ca.gov.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Ulysses Coronel

LICENSING EVALUATOR NAME:

Socorro Leandro

LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC809 (FAS) - (06/04)

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