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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603420
Report Date: 07/07/2022
Date Signed: 07/07/2022 02:14:30 PM

Document Has Been Signed on 07/07/2022 02:14 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:EASTERSEALS PARAMOUNT ADULT DAY PROGRAMFACILITY NUMBER:
198603420
ADMINISTRATOR:REAL, ANGELICAFACILITY TYPE:
775
ADDRESS:16420 & 16424 ORANGE AVETELEPHONE:
(562) 486-3600
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY: 45CENSUS: 17DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Amy Valdiviezo - SupervisorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with Supervisor Amy Valdiviezo and explained the reason for the visit.

The facility is an Adult Day Program (ADP) licensed to serve 45 ambulatory clients, of which 5 may be non-ambulatory, ages 18 and over. The program consists of 1 large single-story building. A tour of the single-story building included: reception area, 3 offices, 3 restrooms, isolation area, kitchen, dining area, 2 activity rooms, computer lab, conference room, and storage room.

LPA toured the facility with Amy Valdiviezo and the following was observed: a total of 3 clients were at the facility during the visit. The staff to client ratio is 1:3. The program site is clean, safe, sanitary and in good repair. All passageways are free from obstruction. Disinfectants, cleaning solutions and poisons are inaccessible to clients and are locked inside the storage room. There are four fire extinguishers and are fully charged. There were multiple smoke alarms throughout the facility. There is a carbon monoxide in the kitchen. The restrooms were observed to be clean and have the required grab bars for non-ambulatory clients. The water temperature was tested in all 3 restrooms and it measured between 117.8 degrees F and 120 degrees F, which is within the required 105-120 degrees F. The program maintains a comfortable temperature in each room/office. The First Aid kit is kept in the kitchen and it is fully stocked with all required items including a current manual. Facility does not keep or administer medications. Food is not prepared at this program and clients are able to bring their own food. The kitchen area has a refrigerator where the clients can store their food. Sharps are kept locked in a office. There are storage bins in the reception area for clients. The last fire/emergency disaster drill was conducted on 02/18/2022 and earthquake drill on 01/20/2022.
(CONTINUED TO LIC 809C)
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: EASTERSEALS PARAMOUNT ADULT DAY PROGRAM
FACILITY NUMBER: 198603420
VISIT DATE: 07/07/2022
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LPA reviewed 4 client files to confirm emergency contact is updated and clients have health screenings on file. LPA reviewed 3 staff records to confirm health screenings, training and fingerprint clearances.

Facility has 30 days supplies of Personal Protective Equipment in the storage room. Facility is following COVID-19 recommendations regarding screening visitors, staff, and clients. Covid-19 prevention signs are posted throughout the facility and hand-washing signs were observed in the bathrooms. Sufficient hand soap, hand sanitizer, and paper towels were observed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.

SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
LIC809 (FAS) - (06/04)
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