<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603103
Report Date: 07/17/2024
Date Signed: 07/17/2024 11:49:33 AM

Document Has Been Signed on 07/17/2024 11:49 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:SVS-LONG BEACH WILLOW INCLUSION CENTERFACILITY NUMBER:
198603103
ADMINISTRATOR/
DIRECTOR:
MEREDITH GYETVAYFACILITY TYPE:
775
ADDRESS:3311 E WILLOW AVETELEPHONE:
(562) 216-5210
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: 21CENSUS: 21DATE:
07/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:28 AM
MET WITH:Program Director Lauren GallardoTIME VISIT/
INSPECTION COMPLETED:
12:00 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 07/17/24 Licensing Program Analysts (LPA) Lizeth Villegas made an unannounced visit to the SVS-LONG BEACH WILLOW INCLUSION CENTER and met with Program Director Lauren Gallardo as the purpose of today's visit was explained. The facility is licensed for a capacity of (21) ambulatory adults ages 18-59 of which (6) may be non-ambulatory. Day program consumers are linked to the Harbor Regional
center. Day program fees are current, there is an active liability insurance with an expiration date of 09/15/2024.

As a part of today's inspection LPA reviewed (5) consumer records, (5) staff records and inspected the physical plant. The day program is a one-story commercial building consisting of (10) rooms, (3) bathrooms, (2) staff offices, a kitchen, leisure room. LPA observed lockers available for clients to store belongings. There are no weapons nor bodies of water on the premises. The day program walls and floors were in good condition, adequate lighting. Plenty of storage space, chemicals and sharps were properly locked. The restrooms were clean and within Title 22 regulations. Landline observed, LPA observed sufficient furniture and lighting throughout the facility, walkways throughout the day program and all exits were clear of hazards and debris. Consumers bring their own snacks however program provides snacks if a consumer did not bring their own.

The last disaster drill was conducted 06/06/24 and a Disaster Plan was on file. The last inspection held by the Long Beach fire department was on 07/25/2023, smoke alarms and carbon monoxide are hardwired and operational. Fire extinguishers were properly charged, and the first aid kit was available and fully stocked.

During today’s visit no discrepancies were observed. Exit interview conducted with Program Director Lauren Gallardo and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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 1