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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004105
Report Date: 08/09/2024
Date Signed: 08/09/2024 04:44:43 PM

Document Has Been Signed on 08/09/2024 04:44 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:COLE VOCATIONAL SERVICES CSIP LONG BEACHFACILITY NUMBER:
306004105
ADMINISTRATOR/
DIRECTOR:		SHERRIE SIMILTONFACILITY TYPE:
775
ADDRESS:3826 ATLANTIC AVETELEPHONE:
(562) 426-4870
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: 30CENSUS: 28DATE:
08/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:41 AM
MET WITH:Sylvia Hernandez & Crystal RobertsonTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On 08/09/2024 at 9:41am, Licensing Program Analysts (LPAs) Zina Brown and Licensing Program Manager Janae Hammond made an unannounced visit to the above facility. The purpose of today's visit was to conduct an annual inspection of the facility. On today's visit LPA Zina Brown met with facility Day Program Supervisor Sylvia Hernandez and Crystal Robertson. The facility has (64) clients currently enrolled in the program. The staff to client ratio is (1) one staff to (3) three clients. The Day Program Supervisors stated none of the clients have restricted health care conditions and one (1) client utilize a protective devices. The last disaster drill was conducted 07/19/2024 and a Disaster Plan was on file. The last inspection held by the fire department was on 07/19/2024. The program does not provide transportation.

As a part of today's inspection LPA reviewed (5) client records, (8) staff records, and inspected the physical plant. The facility does not administrator medication to clients. This is a day program located in one large building consisting of the following: parking lot (drop off/pick up area), lobby area, 4 classrooms (computer, art, library,and style), kitchen with dinning room, (3) staff offices, (2)storage room, and 2 restrooms(unisex).

LPA conducted a tour of the physical plant and observed the following: walls and floors were in good condition, adequate lighting and (2) fire extinguishers were properly charged. LPA observed plenty of storage space and chemicals were properly locked. The restrooms were clean and within Title 22 regulations. The kitchen was clean and a refrigerator was available for client and staff use.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2024
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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Document Has Been Signed on 08/09/2024 04:44 PM - It Cannot Be Edited


Created By: Zina Brown On 08/09/2024 at 01:59 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: COLE VOCATIONAL SERVICES CSIP LONG BEACH
FACILITY NUMBER: 306004105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087.2(a)
Outdoor Activity Space
(a) If outdoor activity space is provided, it shall:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the adult day program did not comply with the section cited above as the program has a designated outside area but is not adequate for client use. According to interview with staff, they are in the process of creating a garden for the clients. Which poses/posed a potential personal rights risk to persons in care.
POC Due Date: 09/09/2024
Plan of Correction
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The facility will create a outdoor activity space by POD due date and submit photo proof by email zina.brown@dss.ca.gov
Section Cited
Outdoor Activity Space
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Janae Hammond
LICENSING EVALUATOR NAME:Zina Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 08/09/2024 04:44 PM - It Cannot Be Edited


Created By: Zina Brown On 08/09/2024 at 01:59 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: COLE VOCATIONAL SERVICES CSIP LONG BEACH
FACILITY NUMBER: 306004105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82064(d)
Administrator -Qualifications and Duties
(d) The administrator shall receive and document a minimum of 30 clock hours of continuing education every 24 months of employment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, LPA did not observe documents a minimum of 30 clock hours of continuing education every 24 months which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/23/2024
Plan of Correction
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The adminstator shall submit proof of continuing education to the department by email at zina.brown@dss.ca.gov by POC Due Date
Section Cited
Personnel Qualifications and Duties
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Janae Hammond
LICENSING EVALUATOR NAME:Zina Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2024


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Document Has Been Signed on 08/09/2024 04:44 PM - It Cannot Be Edited


Created By: Zina Brown On 08/09/2024 at 02:31 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: COLE VOCATIONAL SERVICES CSIP LONG BEACH
FACILITY NUMBER: 306004105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82019(e)(2)
Request the licensee or applicant for a license to request a transfer of a criminal record clearance as specified in Section 82019(f);
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, staff Adahi Perez was not associated to the facility as the time of unannouced inspection which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2024
Plan of Correction
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The facility shall associate staff in Guardian and submit proof of update via email zina.brown@dss.ca.gov by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Janae Hammond
LICENSING EVALUATOR NAME:Zina Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2024


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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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: COLE VOCATIONAL SERVICES CSIP LONG BEACH
FACILITY NUMBER: 306004105
VISIT DATE: 08/09/2024
NARRATIVE
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The day program does not provide lunch however snacks were available to clients. The first aid kit was available and fully stocked. Walkways throughout the day program and all exits were clear of hazards and debris.

LPA observed the following not in compliance:


On 08/09/2024, LPA reviewed Staff #1 file and did not observe a staff working at the facility but there was no criminal record association at the time of visit. According, day program supervisor, staff Adahi Perez is a loaner from another facility.

On 08/09/2024, LPA conducted a file review of the Program Directors file and did not observe an update CPR/first aid certification and observe a continuing education units.

On 08/09/2024, LPA conducted a physical plant tour and observed a designated outside activity area but it was not set up for client use. According to Day Program Supervisor, the facility is in the process of creating a garden as an outdoor activity space.

Civil Penalty assessed.

Deficiencies Cited Under California Code of Regulations Title 22, Division 6, Chapter 3.


Exit interview conducted and a copy of the appeal rights were given.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
LIC809 (FAS) - (06/04)
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