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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221427
Report Date: 01/24/2023
Date Signed: 01/24/2023 02:24:57 PM

Document Has Been Signed on 01/24/2023 02:24 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
GREATER LA AC/SC, 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: 36DATE:
01/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Armine Kim - Area Director TIME COMPLETED:
02:45 PM
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Licensing Program Analyst(s) Mary Flores conducted an unannounced annual visit at the facility with focus on the infection control domain. LPA Flores met with Armine Kim Area Director and explained the reason for the visit.

The facility is licensed as an Adult Day Program with a capacity to serve 131 clients of which 20 may be non-ambulatory. All clients are monitored by Frank D. Lanterman Regional Centers and the facility maintains a staff: client ration of 1 staff per 3 clients. Facility has a lobby, 3 offices, a conference room, an activity area, a dinning area, a kitchen, 3 client restrooms, a computer room, a video room, an isolation room, and a shaded patio.

LPA Flores conducted a tour with Armine Kim Area Director and observed the following:
Facility is in good repair, clean indoor/outdoor. Each activity room is equipped with furniture in good repair. Hand sanitizer and proper signs were observed in each room and hallways. (3) participants bathrooms were observed in working condition, water temperature was tested in each bathroom and water tested between 108.3 - 110.4 degrees F., which is within the required 105-120 degrees F. Facility's kitchen is utilized to prepared cooking activities and stores some cooking items and utensils. A lock cabinet was observed for cleaning supplies. No sharps are kept in the facility. Dining area provides a sitting area for meals. Participants bring their lunch and is stored in facility's refrigerator or kept with the participants. No medications are provided at the facility. LPA observed fire extinguisher's throughout the facility and were last checked on 7/7/22. Facility has a fire sprinkler system. Last fire drill was conducted on 1/11/23. LPA reviewed 3 participant files and 3 staff files. LPA requested a copy of liability insurance.

No deficiencies were given during this visit.

Exit interview was conducted with Armine Kim and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2023
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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