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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005774
Report Date: 03/03/2022
Date Signed: 03/03/2022 02:52:06 PM

Document Has Been Signed on 03/03/2022 02:52 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:EASTERSEALS SENIOR DAY CAREFACILITY NUMBER:
306005774
ADMINISTRATOR:PHILLIPS, KELLYFACILITY TYPE:
775
ADDRESS:3100 E BIRCH STTELEPHONE:
(714) 672-0343
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: 40CENSUS: 37DATE:
03/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Supervisor, Maria Jimenez and Administrator, Kelly PhillipsTIME COMPLETED:
03:00 PM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and was granted entry into the facility by staff . Upon entry LPA's temperature was checked and logged. LPA explained the reason for the visit.

LPA Tirre toured the facility with Supervisor Maria Jimenez. During the visit Administrator Kelly Phillips arrived at facility. Facility is a single story Day Program located inside a Commercial building. At time of visit there were 10 clients in care. LPA observed clients relaxing in Main Room working on activities, games and listening to live musician. Clients appeared clean in appearance and well taken care of. Clients and Staff were observed wearing face masks. All restrooms observed contained working water basin, soap, toilet paper and hand towels.



LPA observed the emergency disaster and evacuation plans posted. Facility has 2 refrigerators for clients to store lunches and pantry with food supply for snacks. Facility has 4 fire extinguishers mounted and fully charged. Facility has provided documentation for operating smoke detectors and Fire clearance from City of Brea with fire inspection date of 4/29/2021. Facility has ample supply of PPE. Facility has a secured location for Client files. LPA reviewed 7 of 7 Clients files during visit. Clients emergency contact information are current. Facility has designated visitation area.

No deficiencies noted during today’s visit. An exit interview was conducted with Administrator Kelly Phillips and a copy of report was left at facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2022
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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