Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number: 198601767
Report Date: 08/04/2022
Date Signed: 08/04/2022 02:25:33 PM
Document Has Been Signed on 08/04/2022 02:25 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: COLE VOCATIONAL SERVICES SIGNAL HILL FACILITY NUMBER:
198601767
ADMINISTRATOR:PORTER, LASONJA FACILITY TYPE: 775
ADDRESS: 2798 JUNIPERO AVE TELEPHONE: (562) 912-7340
CITY: SIGNAL HILL STATE: CA ZIP CODE: 90755
CAPACITY: 30 CENSUS: 10 DATE: 08/04/2022
TYPE OF VISIT: Required - 1 Year UNANNOUNCEDTIME BEGAN: 12:59 PM MET WITH: Jasmin TIME
COMPLETED: 02:20 PM
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25 Licensing Program Analyst (LPA) Perry Scott and LPM Janae Hammond conducted an unannounced Annual Required inspection to the above Adult Day Program (ADP). Upon arriving at the facility LPA/LPM met with Program Supervisor Jasmin Cortes and informed her of the purpose of the visit. The facility is licensed to serve thirty (30) Developmentally Disabled clients, ages 18 - 59 years. (30) NonAmbulatory. Staff to Client ratio is one (1) staff to three (3) clients.
LPA Perry Scott & LPM Janae Hammond and Program supervisor toured the entire physical plant inside and out. Facility consists of the following: Activity Room, Computer Room, Art Room, Gardening Room, Nurse Station, Style Room, Sensory Room, Changing Room, Kitchen, Storage and Administrative offices. The program hours are 8:00am to 12:00pm and from 1:00pm to 5:00 pm Monday through Friday.
Clients bring their own lunches, however the facility has backup food to prepare for clients, if needed.
Facility provides one snack per program session for all clients. There is a nurse on premises that gives clients medications as prescribed. LPA/LPM observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in the facility. Care and Supervision necessary to meet the client's needs and all services specified in the admission agreements are being met.
The last fire extinguisher service date was on 12/21/21. LPA observed the facility walls/ floors were in good condition, and there is adequate lighting throughout the facility. The fire extinguishers were properly charged, smoke and carbon monoxide detectors are operational. The program has ample storage space. The chemicals and sharp objects were properly stored/ locked. The men's and women's restrooms were clean and maintained in a safe and sanitary operating condition; and are sufficient for staff and clients and meet Title 22 regulations. The facilities kitchen appears to be clean and well maintained. The first aid kit was stocked with a manual and available for use. The facility walkways and exits throughout the ADP were clear of hazards and accessible to clients. The hot water temperature was measured and is within Title 22 Regulations (110F).
SUPERVISOR'S NAME: Janae Hammond TELEPHONE: (323) 981-3328 LICENSING EVALUATOR NAME: Perry Scott TELEPHONE: (323) 981-1755 LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
Attachment D
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
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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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: COLE VOCATIONAL SERVICES SIGNAL
HILL
FACILITY NUMBER: 198601767
VISIT DATE: 08/04/2022
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Facility provides lockers to clients for their personal belongings. Facility staff ensure that clients are kept clean and dry, and that the day program facility remains free of odors. The program administration develops, maintains, and implements written plans for orientation and on-the-job training.
And finally, LPA/LPM observed the following to be in compliance: the facility's infection control practices; screening protocols for visitors, staff, and residents; sanitizing stations in common areas and restrooms; every staff was wearing a face covering; the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.
No deficiencies cited. Please note there is a new covid PIN. For adult day program guidance: PIN 22-23 ASC
Exit interview conducted and copy of Report provided to Program Supervisor Jasmin Cortes SUPERVISOR'S NAME: Janae Hammond TELEPHONE: (323) 981-3328 LICENSING EVALUATOR NAME: Perry Scott TELEPHONE: (323) 981-1755 LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number: 198010585
Report Date: 08/19/2022
Date Signed: 08/19/2022 02:46:41 PM
Document Has Been Signed on 08/19/2022 02:46 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
CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LONG BEACH COMMUNITY IMPROVEMENT
LEAGUE
FACILITY
NUMBER:
198010585
ADMINISTRATOR:LAURA SIDNEY FACILITY TYPE: 840
ADDRESS: 2399 CALIFORNIA AVENUE,SUITE A TELEPHONE: (562) 951-3500 CITY: SIGNAL HILL STATE: CA ZIP CODE: 90755
CAPACITY: 29 CENSUS: 9 DATE: 08/19/2022
TYPE OF VISIT: Required - 1 Year UNANNOUNCEDTIME BEGAN: 01:31 PM MET WITH: Laura Sidney TIME
COMPLETED: 03:10 PM
NARRATIVE
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25 An unannounced Required Inspection was conducted on 08/19/2022 at 1:30 PM by Licensing Program Analysts (LPAs) Raul Navarro and Austin Estrada. Facility is currently licensed for a capacity of 29.
Director states there are currently 10 children enrolled. Licensing staff met with Director Laura Sidney.
The program currently operates Monday thru Friday from 7:00am to 6:00pm. LPAs was taken on a guided tour of the facility of both indoors and outdoors.
At the initial start of the site visit, there is a total census of 9 children and a total census of one teacher present. The facility is made up of one classroom. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated.
There were cubbies observed as storage for children's belongings.
Availability of drinking water was reviewed. LPAs observed water fountain and cups in the classroom.
Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. LPAs observed individual toilets (2) and sinks(2) in School Age room.
Toys observed to be clean and free of loose and sharp parts.
A first aid kit is kept in high cabinet upon entry. Carbon monoxide detectors and smoke detectors are present in the facility. Hazardous items including poisonous cleaning compounds were stored and inaccessible to children.
Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment.
SUPERVISOR'S NAME: Karen Chambers TELEPHONE: (323) 980-4934 LICENSING EVALUATOR NAME: Raul Navarro TELEPHONE: 323-981-3388 LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL
SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE
CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LONG BEACH COMMUNITY
IMPROVEMENT LEAGUE
FACILITY NUMBER: 198010585
VISIT DATE: 08/19/2022
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Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness.
LPA's observed the playground to have sufficient shaded are, large play structure with steps and multiple slides with cushioning material to observe a fall. Director understands that the children need to be within the direct care and supervision, including visual supervision of a teacher at all times.
LPAs observed water fountains and cups located in the outdoor play area. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.
Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed.
Children’s Records were reviewed to ensure that Immunization Records are on file , LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and LIC 613A-Personal Rights.
Staff Records were reviewed. Criminal Record Clearances were reviewed for adults. CPR certification.
Inspection of required forms made. LPA reminded Director, that records for all children and staff must be maintained for three (3) years after separation from the facility.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at:
http://www.ada.gov/childqanda.htm
Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
SUPERVISOR'S NAME: Karen Chambers TELEPHONE: (323) 980-4934 LICENSING EVALUATOR NAME: Raul Navarro TELEPHONE: 323-981-3388 LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2022
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL
SERVICES
FACILITY EVALUATION REPORT (Cont) COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, 1000 CORPORATE
CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LONG BEACH COMMUNITY
IMPROVEMENT LEAGUE
FACILITY NUMBER: 198010585
VISIT DATE: 08/19/2022
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Requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov.
At this time, the facility is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today. Exit interview was conducted with Director, Laura Sidney The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected].
For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process SUPERVISOR'S NAME: Karen Chambers TELEPHONE: (323) 980-4934 LICENSING EVALUATOR NAME: Raul Navarro TELEPHONE: 323-981-3388 LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2022
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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number: 197803342
Report Date: 08/02/2022
Date Signed: 08/02/2022 02:11:59 PM
Document Has Been Signed on 08/02/2022 02:11 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
MONTEREY PARK, CA 91754
FACILITY NAME: UNLIMITED QUEST INC LONG BEACH FACILITY
NUMBER:
197803342
ADMINISTRATOR:JOSEPHINE SANTOS FACILITY TYPE: 775
ADDRESS: 3350 OLIVE AVE TELEPHONE: (562) 595-0730
CITY: SIGNAL HILL STATE: CA ZIP CODE: 90807
CAPACITY: 45 CENSUS: 12 DATE: 08/02/2022
TYPE OF VISIT: Required - 1 Year UNANNOUNCEDTIME BEGAN: 12:00 PM MET WITH: ADMINISTRATOR JOSEPHINE SANTOS TIME
COMPLETED: 02:00 PM
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25 On 08/02/2022 at 12:00 PM Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA Calderon was met by Administrator Josephine Santos and the purpose of today’s visit was explained. The facility is licensed to serve 45 adult clients with behavioral issues.
There are currently 12 clients in care all clients are ambulatory. The facility is a 1-story structure with 10 rooms and 5 bathrooms, activity room. kitchen and work out room, teaching rooms, computer room and staff offices.
LPA Calderon and Administrator toured the physical plant. There is no bodies of water or firearm/ammunition on the premises. All client rooms were checked and are in good condition and well maintained. LPA Calderon noted adequate lighting was provided to staff and clients, storage for client personal belongings was observed. Walls and floors were in good repair. All equipment, computers, work stations are well maintained and there is adequately PPE stocked at the time of visit. LPA Calderon observed Bathrooms were found to be within Title 22 regulations and were clean and operational. LPA Calderon noted the following: Bathroom #1 hot water temperature properly measured at 107 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 109 degrees Fahrenheit, Bathroom #3 hot water temperature properly measured at 107 degrees Fahrenheit, and bathroom #4 hot water temperature properly measured at 109 degrees Fahrenheit, finally bathroom #5 hot water temperature properly measured at 107 degrees Fahrenheit. 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. The facilities’ last fire drill was conducted by staff on 07/25/2022. LPA Calderon noted (10) Smoke detectors all were hard wired, 3 Carbon Monoxide was found in the facility.
SUPERVISOR'S NAME: Janae Hammond TELEPHONE: (323) 981-3328 LICENSING EVALUATOR NAME: Jose Calderon TELEPHONE: (323) 213-1153 LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022
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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: UNLIMITED QUEST INC LONG BEACH FACILITY NUMBER: 197803342 VISIT DATE: 08/02/2022
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The facility (4) Fire Extinguishers were checked and found to be fully charged and accessible. Three (3) clients files were reviewed and found to be complete. LPA Calderon reviewed (3) client’s medications and they were all found to be administered according to doctor's orders. Two (2) staff files were checked and have the required documents. The facility does not handle client’s money/cash resources. All the required documents are posted in the facility in a visible area to staff and clients.
During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon did observe screening protocols for visitors, staff and clients, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff were wearing face coverings, an isolation room is confirmed for the facility. LPA Calderon observed the facility has a 30-day supply of Personal Protective Equipment (PPE).
LPA Calderon advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.
During today’s visit there were no deficiencies under California code of regulation title 22, division 6, chapter 8. Exit interview and copy of the report was provided to Administrator Josephine Santos.
SUPERVISOR'S NAME: Janae Hammond TELEPHONE: (323) 981-3328 LICENSING EVALUATOR NAME: Jose Calderon TELEPHONE: (323) 213-1153 LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
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