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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603437
Report Date: 06/23/2022
Date Signed: 06/23/2022 11:09:53 AM

Document Has Been Signed on 06/23/2022 11:09 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:EASTER SEALS SOUTHERN CALIFORNIA INC.FACILITY NUMBER:
198603437
ADMINISTRATOR:BELLARD, LATASHAFACILITY TYPE:
775
ADDRESS:10358 ARTESIA BLVD.TELEPHONE:
(310) 882-8498
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 40CENSUS: 30DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Administrator Latash Bellard TIME COMPLETED:
11:25 AM
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On 6/23/22 at 8:56 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced visit for the purpose of conducting a required annual inspection. Program director Latasha Bellard joined the at visit at 9:20 and toured the facility with LPA. LIS association only shows Program director and no other staff associated. Program director provided LPA with transfer request for all staff. Transfer request was submitted to CCLD on 4/22/22. LPA is assisting Program director with Guardian account.

The facility is licensed to served 40 clients, age 18 and above, of which 25 may be non-ambulatory. The facility consists of administrator office, general office, office, Conference room, work area, staff break room, storage room, food/water storage room, cleaning supply storage room, kitchen, dining area, 3 restrooms, refreshing room, program room, computer room, entertainment room and a sitting area. Smoke / Carbon Monoxide detectors are centralized and were observed in the facility. Facility is also equipped with a centralized sprinkler system.




LPAs discussed infection control practices with program manager and director, toured the facility inside and out, reviewed food supply, reviewed staff files, and reviewed client medication.

Report Continued on 809c

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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: EASTER SEALS SOUTHERN CALIFORNIA INC.
FACILITY NUMBER: 198603437
VISIT DATE: 06/23/2022
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During today’s visit LPA observed all indoor and outdoor passages were free of obstruction. All Bathrooms were observed to be clean and stocked with soap and paper towels. The facility provides emergency meals. Hazardous toxins and/or sharp items are inaccessible to clients. There are no large bodies of water on the premises such as pools. The grounds are well groomed and there were no hazards observed. Cleaning supplies are inaccessible to clients. Trash containers have covered lids. LPA observed that required documents are posted as mandated. LPA observed 30 days of PPE supplies located in a locked storage. LPA observed locked cabinet for medication. The facility is in good repair. During the visit. Staff file reviews contains fingerprint clearance, criminal record statement and transfer request LPA observed the facility infection control practices.


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 to Program Manager, Latasha Bellard.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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