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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603362
Report Date: 08/31/2023
Date Signed: 09/01/2023 09:21:16 AM

Document Has Been Signed on 09/01/2023 09:21 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:DUNGARVIN CALIFORNIA - SIGNAL HILLFACILITY NUMBER:
198603362
ADMINISTRATOR:MARTIN, ALLISONFACILITY TYPE:
775
ADDRESS:695 EAST 27TH STREETTELEPHONE:
(510) 727-9448
CITY:SIGNAL HILLSTATE: CAZIP CODE:
90755
CAPACITY: 30CENSUS: 30DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Program Director Beverly RuizTIME COMPLETED:
12:45 PM
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On 08/31/23 Licensing Program Analysts (LPA) Lizeth Villegas made an unannounced visit to the Dungarvin California-Signal Hill and met with Program Director Beverly Ruiz as the purpose of today's visit was explained. The facility is licensed for a capacity of 30 adults ages 18-59 of which 10 may be non-ambulatory. 18 consumers are at the day program in the morning and 12 consumers in the afternoon. Day program consumers are linked to the Harbor Regional center, the staff to consumer ratio is one (1) staff to three (3) consumers.

As a part of today's inspection LPA reviewed two (3) consumer records, two (2) staff records and inspected the physical plant. The property consists of (1) large building which includes a garden room, music room, art room, tech room offices, Life skills room, gaming room, exercise room, library, conference room, administrative offices, kitchen, (3) unisex bathrooms and an outside patio. The Facility 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, smoke alarms and carbon monoxide are hardwired and operational. 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 meals and program provides snacks only, no medication is administered at day program.

The last disaster drill was conducted 08/07/23 and a Disaster Plan was on file. The last inspection held by the Los Angeles fire department was on 04/23/2023, three (3) 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

Beverly Ruiz and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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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