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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601231
Report Date: 08/03/2022
Date Signed: 08/03/2022 12:27:24 PM


Document Has Been Signed on 08/03/2022 12:27 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, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754



FACILITY NAME:PASW IIFACILITY NUMBER:
198601231
ADMINISTRATOR:JOHN THOMAS PAIZISFACILITY TYPE:
775
ADDRESS:231 E. SPRUCE AVE.TELEPHONE:
(310) 674-1346
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY:30CENSUS: 0DATE:
08/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:John Thomas PaizisTIME COMPLETED:
12:35 PM
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On 8/3/2022, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA met with Program Director John Paizis to explain the purpose of today’s visit and was granted access to the facility grounds.

The facility is a one-story structure located in a commercial building. Facility grounds consists of: talent manager's office, staff office, consumer support office, dance studio, client's locker area, clients break room, two restrooms, wardrobe costume/storage room, multipurpose room, gated parking lot and a shared patio with shaded area.

LPA and day program manager toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected and had adequate lighting furnishings. Bathrooms were found to be within Title 22 regulations and were clean and operational. A comfortable temperature of 74 degrees was maintained.

LPA observed the day program to be sanitary and appropriately supplied at the time of visit. Storage room for cleaning supplies, toxins, and sharps objects were stored and not accessible to consumers. The kitchen was inspected and found all appliances in working condition. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable.

During this visit, LPA observed the day program's infection control practices. LPA observed screening protocols for visitors, staff, and consumers, sanitizing stations in common areas and restrooms. LPA observed staff and consumers were wearing face coverings, LPA observed the facility had a sufficient supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of staff vaccination cards were maintained.

No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a hard copy of this report was provided to Program Director John Paizis
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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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