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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501798
Report Date: 02/13/2024
Date Signed: 02/13/2024 05:45:24 PM


Document Has Been Signed on 02/13/2024 05:45 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:ABILITY FIRSTFACILITY NUMBER:
191501798
ADMINISTRATOR:JULIE MARTINFACILITY TYPE:
840
ADDRESS:480 SOUTH INDIAN HILL BLVD.TELEPHONE:
(909) 621-4727
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:58CENSUS: 10DATE:
02/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Bonita RamosTIME COMPLETED:
06:00 PM
NARRATIVE
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On February 13, 2024, Licensing Program Analyst (LPA) Carolyn Tuba conducted a case management inspection due to an incident that occurred at the facility on 1/23/2024. LPA had conducted a previous visit on 1/25/2024 and was following-up to conduct interviews with staff as they were not available. LPA met with Program Supervisor, Bonita Ramos and LPA obtained a census of 10 participants/students with 5 staff. LPA spoke to Senior Director of Programs, April Stover over the phone to obtain additional information.

The incident was reported to the Department within the required 24 hours of occurrence. The incident consisted with a participant/student leaving the facility. LPA was informed by the facility that the participant had left from approximately 5:00 pm and participant was found at the center by the police department at approximately 10:45 pm. Police Department, as well as parents were informed. LPA was not able to confirm how far the participant was from the facility but it was confirmed that they did in fact leave.


LPA interviewed Staff #1, #2 and #3 to obtain additional information. LPA reviewed participant/student’s file, photos of the gate as well as measurements were taken on 1/25/2024. LPA interviewed Parent #1 (P1) on 2/5/2024. LPA spoke with Senior Director of Programs who stated that there was already a staff meeting held on February 5, 2024, additional staff meeting of Active Supervision and Training/Missing person procedures will be held on 2/15/2024. Agenda and signatures of staff in attendance will need to be provided. There was an alarm installed and on 2/13/2024 LPA along with Program Supervisor tested and confirmed that the alarm is loud enough to hear through-out the facility should the back gate be opened.

During the visit LPA conducted a Bodies of Water Checklist to confirm that the pool that is located at the facility is safe for children in care. According to the Program Supervisor the pool has not been used since January 5, 2024.


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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ABILITY FIRST
FACILITY NUMBER: 191501798
VISIT DATE: 02/13/2024
NARRATIVE
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Based on Interviews and documentation One (1) Type A is being cited during today's visit - A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Julie Martin.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/18/2024 04:47 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/10/2024 09:09 AM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: ABILITY FIRST
FACILITY NUMBER: 191501798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and
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Per Senior Director of Programs, Staff meeting will be held on 2/15/2024 and agenda and signatures of staff will be provided to LPA via email. Director will provide new protocols and a bell has been installed at the gate to notify when opened and LPA has tested.

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101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by: Child wandered away from the facility and which poses/posed an immediate health, safety or personal rights risk to persons in care.
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A Civil Penalty Assessment of an immediate $500 was accessed on 4/12/2024.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
LIC809 (FAS) - (06/04)
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