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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005774
Report Date: 02/13/2023
Date Signed: 02/13/2023 01:06:18 PM

Document Has Been Signed on 02/13/2023 01:06 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 & INLAND A/SC, 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: 38DATE:
02/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Jill EfronTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by front desk staff. LPA met with Jill Efron, Director and LPA explained the nature of the visit.

LPA Martinez accompanied by Director began the tour of the physical plant of the facility. There are 38 clients in day program and there is no active covid case in the facility. There is a sign-in procedure in place and hand sanitizer for use, LPA was checked in with temperature check. LPA observed clients having lunch at the time of visit. LPA observed required department postings and covid precautionary postings throughout the facility. The facility has a Mitigation Plan on file with CCLD. Facility has required Emergency Disaster Plan posted. The facility is equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Facility has an emergency food and water supply. Facility has 2 refrigerators for clients to store lunches and pantry with food supply for snacks. Personal protective equipment (PPE) supply is available. All bathrooms observed to have a supply of soap, toilet paper and paper towels. Facility has a secured location for Client files.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Director and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2023
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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