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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603420
Report Date: 07/06/2023
Date Signed: 07/06/2023 11:50:49 AM

Document Has Been Signed on 07/06/2023 11:50 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
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: 18DATE:
07/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Supervisor Amy Valdiviezo TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced annual visit at the facility which included the following domains:
Infection Control, Physical Plant and Environmental Safety, Operational Requirements, Staffing, Personnel Records- Training, Client records- Incident Reports, Client rights- Information, Food Service, Health Related Services, Incidental Medical Services, Disaster Preparedness, and Emergency Intervention.
LPA Trueman met with Supervisor Amy Valdiviezo and explained the reason for the visit.
Shortly thereafter administrator Angelica Real arrived.

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: There were 0 clients at the facility during the visit. Clients were at an activity in the community. 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 108.5 F., 110.1F. and 115.3 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.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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: 07/06/2023
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 The last fire/emergency disaster drill was conducted on 02/23/2023 and earthquake drill on 01/20/2023.

LPA reviewed 6 client files and 6 Staff files.

Facility has 30 days supplies of Personal Protective Equipment in the storage room.

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: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC809 (FAS) - (06/04)
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