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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603437
Report Date: 05/21/2024
Date Signed: 05/21/2024 12:48:43 PM

Document Has Been Signed on 05/21/2024 12:48 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA INC.FACILITY NUMBER:
198603437
ADMINISTRATOR/
DIRECTOR:		BELLARD, LATASHAFACILITY TYPE:
775
ADDRESS:10358 ARTESIA BLVD.TELEPHONE:
(310) 882-8498
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 40CENSUS: 23DATE:
05/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:14 AM
MET WITH:Maricruz Bellosa - Program SupervisorTIME VISIT/
INSPECTION COMPLETED:
01:04 PM
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced visit for an Annual Inspection. Upon arrival, LPA met with Maricruz Bellosa (Program Supervisor), and Latasha Bellard (Program Director) later assisted with the visit, the purpose for the visit was explained. The facility is licensed to serve 40 Adults ages 18 and above with todays census at 23.

This is a single- story facility located in Bellflower, Ca. A tour of the facility includes: Kitchen/Activity Area, 2 Additional Activity Rooms, Storage Room, File Room, Conference Room, Entertainment Room with TV, Computer, Staff Break Room with Fire Panel Closet, 3 Offices, 2 Private Restrooms, 1 Restroom with stalls and a Shaded Outdoor Activity Area.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:
Infection Control: The facility staff are using appropriate hand hygiene and cleaning/disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan.
Physical Plant & Environment Safety: Smoke detectors and carbon monoxide detectors are operable and in compliance, there is an emergency sprinkler system throughout the facility. The fire extinguishers were observed and are fully charged. No bodies of water were observed at the facility. The hot water temperature was tested throughout the facility restrooms and measured within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, poisons and hazardous items are stored in a secured/locked storage closet and inaccessible to clients. There is a shaded rest area provided for the clients. Clients are provided with a non-contaminating water container that is readily available for indoor and outdoor use within refrigerator and bottled water for clients. The facility appears to be clean safe and sanitary.
Operational Requirements: The facility has the appropriate fire clearance. Staff are knowledgeable on their reporting requirements. (Continued on 809-C)
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA INC.
FACILITY NUMBER: 198603437
VISIT DATE: 05/21/2024
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Staffing: There appears to be sufficient staffing at all times in the facility. There are at least 2 staff members on duty any time there are clients in the facility.
Personnel Records-Training: Staff files were readily available during visit. LPA reviewed 5 staff files, each file reviewed have criminal record clearance, current First Aid/CPR and sufficient on-going training. Program Director has proper training and experience to meet the requirements.
Client Records-Incident Reports: Client files are kept in a secure location within the staff office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Consent Forms, and Appraisal Needs & Services Plan. LPA reviewed 5 client records without any issues.
Client Rights-Information: Client Rights Poster is posted within the facility.
Food Service: Pesticides and other similar toxic substances are not stored in food storerooms or other kitchen areas.
Health Related Services: Staff responsible for providing direct care and supervision maintain training in First-Aid/CPR.
Incidental Medical & Dental: Staff have proper training documented within the personnel files and reviewed annually.
Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and relocation sites.
Emergency Intervention: Clients at this facility have not needed the use of restraints or the use de-escalation techniques.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during today’s visit.

Exit interview was held and a copy of the report was provided to Latasha Bellard.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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