306004105-10-3-2023-11-AS-MLEN-CWA22T-20231003170115

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004105
Report Date: 10/03/2023
Date Signed: 10/03/2023 05:01:31 PM

Document Has Been Signed on 10/03/2023 05:01 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	COLE VOCATIONAL SERVICES CSIP LONG BEACH		FACILITY NUMBER:	306004105
ADMINISTRATOR:	SHERRIE SIMILTON		FACILITY TYPE:	775
ADDRESS:	3826 ATLANTIC AVE		TELEPHONE:	(562) 426-4870
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY: 30		CENSUS: 30	DATE:	10/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:52 AM
MET WITH:	Cristina Gomez, Program Director		TIME COMPLETED:	05:08 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	On 10/03/2023 at 11:00 AM Licensing Program Analyst (LPA) Mario Leon conducted an unannounced Annual required visit TO Cole Vocational Services (CSIP) Long Beach Facility using the CARES tool. LPA Leon was met by Program Supervisor, Silvia Hernandez (S2) and later by Program Manager, Cristina Gomez (S1), and the purpose of today’s visit was explained. The facility is licensed to serve 30 adult clients with behavioral issues. There are currently sixty-six (66) clients in care, six (6) clients receiving services remotely. There are 30 clients present during the AM shift and 30 clients during the PM shift. The facility is a 1-story structure with 9 rooms and 2 bathrooms including an activity room. kitchen, workout room, teaching rooms, computer room, staff offices and 2 storage rooms. LPA Leon and S2 toured the physical plant. There is no bodies of water or firearms/ammunition on the premises. All client rooms were checked and are in good condition and well maintained. LPA Leon noted adequate lighting was provided to staff and clients, storage for client personal belongings was observed. Walls and floors were in good repair. All equipment, computers, work stations are well maintained and there is adequate PPE stocked at the time of visit. LPA Leon observed the computer room (room 2) and rooms five (5) and nine (9) appear not to be used as shown on floor plan which was updated 5/2023. LPA Leon observed bathrooms were found to be within Title 22 regulations and were clean and operational. LPA Leon noted the following: Bathroom #1 hot water temperature properly measured at 119.3 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 109 degrees Fahrenheit, Kitchen hot water temperature properly measured at 107 degrees Fahrenheit. LPA Leon observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for cleaning agents, toxins, and sharps were not accessible to clients and located in storage number two. The facilities’ last earthquake drill was conducted on 09/28/23 and the last fire drill was conducted by staff on 09/29/2023. LPA Leon noted (11) Smoke detectors all were hard wired, two (2) Carbon Monoxide was found in the facility. The facility (3) Fire Extinguishers were checked and found to be fully charged and accessible. Report continues, see LIC809-C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: COLE VOCATIONAL SERVICES CSIP LONG BEACH	FACILITY NUMBER: 306004105
	VISIT DATE: 10/03/2023

NARRATIVE

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Three (3) clients files were reviewed and found to be complete. Three (3) staff files were checked and LPA Leon found that all three (3) staff folders did not contain medical assessment. The facility does not handle client’s money/cash resources. All the required documents are posted in the facility in a visible area to staff and clients.

During the visit, LPA Leon observed the facility infection control practices. LPA Leon did observe screening protocols for visitors, staff and clients, sanitizing stations (Located in common areas and restrooms). LPA Leon observed staff were wearing face coverings. LPA Leon observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPA Leon advised the Program Manager, Cristina Gomez, to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

During today’s visit there was one (1) deficiency cited under California code of regulation title 22, division 6, chapter 8, See LIC809-D. There was one (1) Technical Assistance note provided, see LIC9102-AN Exit interview a copy of the report and the appeal rights were provided to Program Manager, Cristina Gomez.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/03/2023 05:01 PM - It Cannot Be Edited

Created By: Mario Leon On 10/03/2023 at 03:56 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: COLE VOCATIONAL SERVICES CSIP LONG BEACH	FACILITY NUMBER: 306004105
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82065(g)(1)

Personnel Requirements

(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA record review, the licensee did not comply with the section cited above in three out of three staff folders which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/10/2023
	Plan of Correction
1 2 3 4	LPA and Program Director, Cristina Gomez, have agreed that the facility will update all staff folders to contain the LIC503.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Ulysses Coronel

LICENSING EVALUATOR NAME:

Mario Leon

LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC809 (FAS) - (06/04)

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