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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602577
Report Date: 08/23/2024
Date Signed: 08/23/2024 03:23:43 PM

Document Has Been Signed on 08/23/2024 03:23 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:CALIFORNIA EMPLOYMENT DEV & SUPPORT SERVICES INCFACILITY NUMBER:
198602577
ADMINISTRATOR/
DIRECTOR:		ENUNWA, JOHNFACILITY TYPE:
775
ADDRESS:14127-14127 1/2 CRENSHAW BLVDTELEPHONE:
(310) 617-5912
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 30CENSUS: 26DATE:
08/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:51 AM
MET WITH:MANAGER TANIKA HORTONTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 08/23/2024 at 09:00 AM Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced Annual required visit California Employment Dev & Support Services Inc facility. LPA Calderon was met by Manager Tanika Horton and the purpose of today’s visit was explained. The facility is licensed to serve 30 adult clients with behavioral issues.

There are currently 26 clients in care all clients are ambulatory. The facility is a one-story commercial structure with (4) rooms and (2) bathrooms, activity room. kitchen and work out room, teaching rooms, computer room and staff offices.

LPA Calderon and Manager Tanika Horton toured the physical plant. There is no bodies of water or firearm/ammunition on the premises. All client rooms were checked and are in good condition and well maintained. LPA Calderon noted adequate lighting was provided to staff and clients, storage for client personal belongings was observed. Walls and floors were in good repair. All equipment, computers, workstations are well maintained and there is adequately PPE stocked at the time of visit. LPA Calderon observed Bathrooms were found to be within Title 22 regulations and were clean and operational. LPA Calderon noted the following: Bathroom #1 hot water temperature properly measured at 107 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 109 degrees Fahrenheit, finally the Kitchen hot water temperature properly measured at 108 degrees Fahrenheit. LPA Calderon observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were not accessible to clients. The facilities’ last fire drill was conducted by staff on 08/09/2024. LPA Calderon noted (4) Smoke detectors all were hard wired, (2) Carbon Monoxide was found in the facility. The facility (3) Fire Extinguishers were checked and found to be fully charged and accessible. Three (3) clients files were reviewed and found to be complete. LPA Calderon reviewed (3) client’s medications and they were all found to be administered according to doctor's orders.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CALIFORNIA EMPLOYMENT DEV & SUPPORT SERVICES INC
FACILITY NUMBER: 198602577
VISIT DATE: 08/23/2024
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Three (3) staff files were checked and have the required documents. The facility does not handle client’s money/cash resources. Commercial General Liability Policy #G8A6GL000031900 policy period from 08/06/2024 to 08/06/2025 underwritten by American Southern Home Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. All the required documents are posted in the facility in a visible area to staff and clients.

During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon did observe screening protocols for visitors, staff, and clients, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff were not wearing face coverings, an isolation room is confirmed for the facility. LPA Calderon observed the facility has a thirty-day supply of Personal Protective Equipment (PPE).

LPA Calderon advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.



During today’s visit there were no deficiencies under California code of regulation title 22, division 6, chapter 8. Annual Licensing Fee is CURRENT Exit interview and copy of the report was provided to Manager Tanika Horton.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC809 (FAS) - (06/04)
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