306001666-9-17-2025-22-AS-JHAY-DLLQC2-20250917120224

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306001666
Report Date: 09/17/2025
Date Signed: 09/17/2025 12:02:37 PM

Document Has Been Signed on 09/17/2025 12:02 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	EMPOWER COMMUNITY DAY PROGRAM		FACILITY NUMBER:	306001666
ADMINISTRATOR/ DIRECTOR:	MICHAEL J. MURPHY		FACILITY TYPE:	775
ADDRESS:	8381 KATELLA AVE. STE C,D, & E		TELEPHONE:	(310) 902-2562
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY: 72		CENSUS: 67	DATE:	09/17/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:40 AM
MET WITH:	Michael Murphy		TIME VISIT/ INSPECTION COMPLETED:	12:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year annual Inspection. LPA Haley entered the day program and was greeted by staff and explained the reason for the visit. The program has a capacity of 72 and operates Monday through Friday, from 8:00 AM - 2:00 PM. The program consist of three suites (C, D, & E) that all have an open classroom style setting. All suites have a bathroom equipped with a working toilet and sink for a total of 3 sinks and 3 toilets for the participants. Grab bars were secured to the wall. The program offers virtual services to two participants as well. In addition to the three classroom style activity areas, the program has a computer lab with eight computer stations in suite D , and a library in suite E. In suite C there’s a meeting room with a table and chairs. Fire extinguishers were serviced and inspected by Cintas, and the fire sprinkler system is inspected by the owner of the building. The program has a kitchen area in suite D equipped with a refrigerator and coffee maker. No sharp or hazardous chemicals are stored in the kitchen area. Participants bring their own lunch and on Fridays the participants eat out. Emergency supplies and the first aid kit are stored in the front office of suite C. During the inspection, participants were observed in the three different suites, working on various activities. LPA observed fully charged fire extinguishers in each suite, and in the Administration Office(s) on the second floor. Continued on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jerome Haley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EMPOWER COMMUNITY DAY PROGRAM	FACILITY NUMBER: 306001666
	VISIT DATE: 09/17/2025

NARRATIVE

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The second floor is off limits to the participants and staff files are stored in the Executive Director’s office. Participant files are electronic, and the facility provided a computer to access participant files and complete the file review for the inspection.

During the visit, 7 staff files were reviewed and 7 participant files were reviewed. During the visit, Executive Director (ED) Michael Murphy provided LPA a copy of a receipt dated September 4, 2025, for fees that were paid. ED Murphy also provided the correct facility contact numbers and a copy of the liability insurance policy.

No deficiencies are being cited during today’s visit. An exit interview conducted, and a copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jerome Haley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

LIC809 (FAS) - (06/04)

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