198600405-6-20-2024-11-AS-RCLD-D6EQD6-20240620120412

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600405
Report Date: 06/20/2024
Date Signed: 06/20/2024 12:04:20 PM

Document Has Been Signed on 06/20/2024 12:04 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	EASTER SEALS SOUTHERN CALIFORNIA COTA		FACILITY NUMBER:	198600405
ADMINISTRATOR:	SANKA, DIANE F		FACILITY TYPE:	775
ADDRESS:	2251 TORRANCE BLVD		TELEPHONE:	(310) 618-9527
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	30	CENSUS: 26	DATE:	06/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:39 AM
MET WITH:	Program Supervisor Ellamay Cruz		TIME COMPLETED:	12:20 PM

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On 06/20/24 at 8:39 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Program Supervisor Ellamay Cruz. LPA explained the purpose of the visit and was accompanied by Supervisor inside the facility during this inspection.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: open café, garden room, small outdoor patio, two restrooms, office, activity space, gathering space, reception area, conference room, and computer room.

This facility is licensed to serve developmentally disabled adults ages 18 – 59 years: up to a total of 30 clients, 23 of which could be non-ambulatory. Annual fees are current.

Patio furniture is available for area with umbrellas. There are no security bars or weapons on the premises.

All client spaces were checked and are in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. All equipment, computers, and workstations are well maintained. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were not accessible to clients. Open cafe was inspected and observed to be clean and operational. The clients bring their own food. Bathroom toilets and water faucets worked properly.

This facility does not currently store medications for clients, but a locked storage is available for clients medications if needed.

Smoke and carbon monoxide detectors were in compliance and operational. The last facility fire drill was on March 2024. Documents are posted as mandated.

Continue to LIC-809C.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA COTA	FACILITY NUMBER: 198600405
	VISIT DATE: 06/20/2024

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5 Staff records were reviewed, 5 out of 5 staff records reviewed had required criminal record clearances on file.

5 Client records were reviewed, 5 out of 5 client records reviewed contained an IPP (Individual Program Plan), IEP (Individual Education Plan), and/or annual assessment, admission agreement, identification emergency information, medical assessment, and personal rights.

No deficiencies cited.

An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with Program Supervisor Ellamay Cruz.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC809 (FAS) - (06/04)

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