<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006002
Report Date: 12/18/2024
Date Signed: 12/18/2024 11:05:15 AM

Document Has Been Signed on 12/18/2024 11:05 AM - 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 SERVICESFACILITY NUMBER:
306006002
ADMINISTRATOR/
DIRECTOR:		FAROOQUEE, EVELYNFACILITY TYPE:
775
ADDRESS:1570 E 17TH STREETTELEPHONE:
(714) 672-0866
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 50CENSUS: 48DATE:
12/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Maria Vega, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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) Lydia Martinez made an unannounced visit for the purpose of conducting a Required - 1 Year inspection. LPA arrived at facility and was greeted at the front desk by Job Coach Flora May Johnson and ADS Program Coordinator Ramona "Mona" Ramirez and reason for visit was explained. Program Director Maria Vega arrived shortly after. There were a total of 48 Clients who checked in, of those 30 were out in the community on today's date; 18 were present at the facility.

LPA, along with Mona toured the facility. The facility is in a commercial business complex. There are 3 buildings on the premises. The first building is the front entrance, Reception, Staff kitchen, Staff offices and a Computer Lab. The second building has an 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, Conference Room, and more Staff offices. The kitchen has refrigerators, microwave, Air fryer 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 08/23/2024. Emergency Drills are conducted monthly and the last drill was 11/20/2024. 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. Eighteen clients were present during the visit. LPA observed clients interacting and participating in recreational activities and listening to music. Several activities are available and offered at the facility, such as, board games, reading books, music instruments, arts & craft, and Yoga/exercising videos. Facility offers and teaches clients on social/life skills, such as, courtesy, respect for others, and mannerisms. Clients were observed to be 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.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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: 12/18/2024
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
 LPA inspected restrooms and hot water temperature is within regulatory requirements. All restrooms observed to have a supply of soap, toilet paper and 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 of the facility have an alarm. LPA reviewed six client files. All the required documentation was present and current. LPA reviewed four employee records. All employees reviewed have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate and CPI training.

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 Program Director Vega and a copy of this report was sent to email provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2