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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603806
Report Date: 09/24/2024
Date Signed: 09/24/2024 10:19:12 AM

Document Has Been Signed on 09/24/2024 10:19 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EASTERSEALS ADULT DAY SERVICESFACILITY NUMBER:
198603806
ADMINISTRATOR/
DIRECTOR:
VASQUEZ, ERICKFACILITY TYPE:
775
ADDRESS:1223 E ROUTE 66TELEPHONE:
(626) 856-1601
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY: 50CENSUS: 0DATE:
09/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:46 AM
MET WITH:Mandy Speakman - Regional Director
Erick Vasquez - Administrator
TIME VISIT/
INSPECTION COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Mary Flores conducted an announced Pre-Licensing visit at the location. LPA met with Mandy Speakman Regional Director and Erick Vasquez Administrator, applicants.

Facility was approved by the Fire Department 9/13/24 for a total capacity of 50 non-ambulatory clients. The facility is located in a commercial area, consist of a single story building with a kitchen, (4) restrooms, a conference room, (2) office areas, a computer lab, a laundry area, (3) large activity spaces, a nurse station with storage closet, (2) personal care rooms, a private room, a quiet space area, a file room, a janitor's closet, locker area, an outdoor area, and several storage spaces.

LPA Flores conducted a tour of the facility with Mandy Speakman and observed the following:
The building is in good repair indoor and outdoor. All passageways and ramps are free of obstructions and debris. Building is equipped with a fire sprinkler system throughout. Fire extinguishers were observed and last checked on 5/2/24. Each area is set up to accommodate clients receiving services with furniture and materials for activities. The kitchen has a refrigerator that will be used for storing client's meals. A pantry across from the kitchen will be use to store sharps and other items that must be kept inaccessible from clients. Chemicals will be store in a closet cabinet outside bathroom #1. Each bathroom has a working toilet, and sensor water faucets. Water temperature was tested in the kitchen at 116.6 degrees F., which is within the required 105-120 degrees F. Facility has sufficient lighting throughout. There is a cover patio with chairs to provide outside space. There are no large bodies of water. Client rights and other materials have been posted. First Aid kit was reviewed and meets the requirements.

LPA reviewed a copy of the Emergency Disaster plan and Infection Control plan, both meet the regulatory requirements.
The facility meets Title 22 Regulations.
Exit interview was conducted with applicants and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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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