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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221427
Report Date: 02/09/2022
Date Signed: 02/09/2022 12:43:18 PM

Document Has Been Signed on 02/09/2022 12:43 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. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:AVANTI ADULT SERVICESFACILITY NUMBER:
191221427
ADMINISTRATOR:SAMUEL ANUAKPADOFACILITY TYPE:
775
ADDRESS:60 NORTH DAISY AVENUETELEPHONE:
(626) 564-0191
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 131CENSUS: 10DATE:
02/09/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Armine Kim - Area Director TIME COMPLETED:
01:00 PM
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Licensing Program Analyst(s)(LPA) Mary Flores conducted a plan of correction (POC) visit to follow up on deficiencies given during annual visit conducted on 1/26/22. LPA Flores met with Armine Kim Area Director and explained the reason for the visit.

Section 82087(a)(3) Building and Grounds: On 1/26/22 LPA Flores conducted an unannounced annual visit and observed cleaning supplies in kitchen area unlock in cabinet under sink.

During this visit LPA Flores observed cleaning supplies locked in a kitchen cabinet with a key lock. All other cleaning supplies were removed from under the sink. Deficiency has been cleared as of 2/9/22.

Section 82088 (e)(1) Fixtures, Furniture, Equipment, and Supplies: On 1/26/22 LPA Flores conducted an unannounced annual visit during the visit water temperature was tested at in men's restroom at 124 degrees F., in women's restroom at 125 degrees F., and in activity room's restroom at 61.3 degrees F. which is not within the required 105 - 120 degrees F.

During this visit LPA Flores tested water temperature in the men's restroom at 132.8 degrees F. and in the women's restroom water temperature tested at 131.7 degrees F. and activity room's restroom water temperature was tested at 121.0 degrees F., which is within the required 105 - 120 degrees F. Deficiency has not been cleared and civil penalties are being assess for failure to correct for a total of 14 days from 1/27/22 - 2/9/22 for the amount of $1400.00.
Civil Penalties are noted on LIC 421FC

Exit interview was conducted with Armine Kim Area Director and a copy of this report, LIC 421FC, and appeal rights were provided.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2022
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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