306006002-12-4-2023-22-AS-RMAZ-CY7TYE-20231204140836

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006002
Report Date: 12/04/2023
Date Signed: 12/04/2023 02:08:42 PM

Document Has Been Signed on 12/04/2023 02:08 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:	EASTERSEALS ADULT DAY SERVICES		FACILITY NUMBER:	306006002
ADMINISTRATOR:	ROXAS, MERVIN		FACILITY TYPE:	775
ADDRESS:	1570 E 17TH STREET		TELEPHONE:	(714) 672-0866
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY: 50		CENSUS: 28	DATE:	12/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:			TIME COMPLETED:	02:40 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) Ruth Martinez made an unannounced visit for the purpose of conducting an annual required visit. LPA arrived at facility was greeted at the front desk by Evelyn Farooquee, Administrator and LPA explained the reason of the visit.

LPA accompanied by Administrator began the tour of the day program. The facility is in a commercial business complex. There are 3 buildings on the premises. The first building is the front entrance, offices and the computer lab. The second building has the activity room, arts and craft room as well as a room for staff training. The third building is the kitchen/dining room as well as a tv room and more offices. The kitchen has refrigerators, microwaves and a stove/oven. No toxins/sharps will be available to clients. There is ample space for clients to store their belongings and lunches. LPA observe that the facility fire clearance is maintained in conformity with the State Fire Marshall regulatory standards. Fire Extinguishers were observed to be mounted on the wall throughout the facility. Smoke detectors and sprinkler systems are serviced by an outside vendor, and LPA verified last inspection was completed on November 14, 2023. Fire drill are conducted twice a year and the last drill was August 17, 2023. Earthquake drills are conducted twice a year and the last drill was conducted on October 19, 2023. Disinfectants cleaning solutions and poisons are inaccessible to clients and stored in locked storage closet. The day program is maintained in a clean, safe, and sanitary condition. The premises and furnishings are in good repair. There is no food preparation at this site. Clients provide their own lunches and are stored in facility refrigerator. Clients were in a class session at the time of visit and are adequately supervised to meet their needs. Facility does not handle client’s medication. First aid supplies are adequate, and LPA observed several first aid kits mounted on the wall throughout the facility. LPA inspected restrooms and LPA measured the hot water temperature which measured 105.1 Fahrenheit degrees. All restrooms observed to have a supply of soap, toilet paper and

Continued on LIC809-C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: EASTERSEALS ADULT DAY SERVICES	FACILITY NUMBER: 306006002
	VISIT DATE: 12/04/2023

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
26
27
28
29
30
31
32

towels. The three buildings have ample seating space and supplies. LPA also observed an isolation room for clients who need a quiet space and/or are not feeling well. The outside patio has a fountain with shade. The doors that lead outside have an alarm. LPA began review of records. LPA reviewed three clients’ records. All the required documentation was present and current in the client’s files reviewed. LPA reviewed three employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate.

Based on the observations 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 Administrator 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: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2