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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603784
Report Date: 01/16/2025
Date Signed: 01/16/2025 04:41:58 PM

Document Has Been Signed on 01/16/2025 04:41 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:C-H ADULT DAY CENTER PROGRAM #2FACILITY NUMBER:
198603784
ADMINISTRATOR/
DIRECTOR:
HARTWELL, MAXINEFACILITY TYPE:
775
ADDRESS:15744 CALIFORNIA AVETELEPHONE:
(562) 630-8123
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY: 30CENSUS: 0DATE:
01/16/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Maxine Hartwell, licenseeTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted a pre-licensing inspection on 1/16/25. LPA met with licensee, Maxine Hartwell. The fire clearance is granted for a capacity of (30) clients, of which (6) may be non-ambulatory. The second floor is not approved for any clients. The hours of operation is from 7:30am - 3:30pm, Monday through Friday.

LPA inspected the day program using the Compliance and Regulatory Enforcement (CARE) tools and completed the Component III.
The facility consists of a reception area, 2 rooms by the front area which will be used for meetings and for rest, a large activity room, storage room, kitchen, and 2 restrooms. There is no stove range in the kitchen. The facility has at least one operable carbon monoxide detector and interconnected smoke detectors. There are surveillance cameras placed in each of the rooms used by clients except for restrooms. The second floor consists of 3 storage rooms and will not be utilized by clients. The building and grounds are free of hazards for both indoor and outdoor. Cleaning supplies are locked in the storage room. Facility will not use any knives at the facility. There are sufficient amount of plastic cups, paper bowls/plates, and utensils. The main activity room has sufficient chairs and tables to conduct activities. There are also 2 hand washing stations and a water dispenser (hot and cold water) located in the main room. Medications will be centrally stored and locked in a smaller container. The water temperature is measured at 113.7 which is within the required range. There are 2 refrigerators at the facility and may be used by clients to store their foods. Clients will be bringing their own lunch and snacks to the program. The first aid kit has the appropriate supplies and the manual. There is space for storing client's personal belongings. Per the licensee, the staff and client records will be maintained at the site. The Emergency Disaster Plan, Personal Rights, and Complaint procedures are posted at the facility. The facility landline is (562) 630-8123.

Pre-licensing is complete and there are no deficiencies. Exit interview was held and a copy of this report was provided to the licensee.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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