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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602929
Report Date: 05/21/2024
Date Signed: 05/21/2024 03:58:15 PM

Document Has Been Signed on 05/21/2024 03:58 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:WORK & SERVICE COALITIONFACILITY NUMBER:
198602929
ADMINISTRATOR/
DIRECTOR:		ARO, REYNALDOFACILITY TYPE:
775
ADDRESS:12626/12628 BELLFLOWER BLVDTELEPHONE:
(562) 401-0377
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 30CENSUS: 13DATE:
05/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Program Director Daisy MirallesTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Tyler Reyes and Jose Villalobos conducted an unannounced required annual inspection using the CARE tools. LPAs met with Program Director Daisy Miralles and explained the reason of the visit.

The facility is an Adult Day Program (ADP) licensed to serve 30 ambulatory clients and vendored SLARC.

Infection Control: LPA observed the facility has sufficient PPE supplies. Infection Control Plan is in place. The plan was collected and reviewed.

Physical Plant and Environmental Safety: The program consists of 1 large single-story building. A tour of the single-story building included: reception area, 2 offices, 2 restrooms, kitchen, 2 activity rooms, computer lab, and storage room. LPA toured the physical plant during the visit.

Operational Requirements: Facility is operating within its approved clearance.

Staffing: There are no clients present during the visit. LPAs were not able to observe Staff-Client Ratios. Sufficient staff was observed via facility roster.

Personnel Records-Training: Personal records centrally stored. LPA inspected five (5) staff files. All staff are fingerprint cleared. Required documentation observed in each file.

Client's Right - Information: No, postural support documentation observed. Required postings observed.

Continued on LIC 809-C
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: WORK & SERVICE COALITION
FACILITY NUMBER: 198602929
VISIT DATE: 05/21/2024
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Food Service: Pesticides and other toxic substances were not stored with the food supply. Cleaning supplies were stored in locked cabinets inaccessible to clients in care. Kitchen area was clean.

Client Records/Incident Reports: Client files are centrally stored. LPA reviewed six (6) client files. Client files are up to date and have required documents.

Health Related Services: There are no clients in care who receive assistance with medications. No medication files to observe.

Incidental Medical Services: There are no clients in care with prohibited or restricted health conditions. First Aid kid observed and available when needed.

Disaster preparedness: The facility is currently using the old LIC 610D Emergency Disaster Plan . The plan was reviewed. Facility has client information readily available in case of emergencies. Last emergency drill was conducted don 5/3/24

Emergency Intervention: The facility are not using any restraints in the facility.


Per Title 22 Regulations, no deficiencies are being cited on todays visit.

Exit Interview conducted. A copy of the LIC 809 was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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