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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221427
Report Date: 12/01/2023
Date Signed: 12/01/2023 11:31:11 AM

Document Has Been Signed on 12/01/2023 11:31 AM - 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: 24DATE:
12/01/2023
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Armine Kim, Administrator TIME COMPLETED:
11:34 AM
NARRATIVE
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual visit at the facility with for annual inspection LPA Lopez 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 Center, San Gabriel and ELA 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 dining area, a kitchen, 3 client restrooms, a computer room, a video room, and an isolation room.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting clients.. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies. An Infection Control Plan was at the facility.



Physical Plant & Environment Safety: The facility is free of debris/hazards. There are no security bars or weapons on the premises. The hot water temperature was tested, and temperature measured between 108.3-111.3 degrees F which is within required range of 105.0 -120.0 F. All storage areas for cleaning solutions, toxins, and hazardous items are inaccessible to clients. Cabinet with cleaning solutions was locked. Smoke detectors and carbon monoxide detectors are operable and in compliance. The fire extinguishers were observed and recently inspected. One window in the men's restroom is cracked and needs repair or replacement.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
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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Document Has Been Signed on 12/01/2023 11:31 AM - It Cannot Be Edited


Created By: Alberto Lopez On 12/01/2023 at 11:07 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: AVANTI ADULT SERVICES
FACILITY NUMBER: 191221427

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. One window in men's bathroom is cracked which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2023
Plan of Correction
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Facility will repair or replace window in men's bathroom and send proof to LPA by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023


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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: AVANTI ADULT SERVICES
FACILITY NUMBER: 191221427
VISIT DATE: 12/01/2023
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Operational Requirements: Facility is complying with operational requirements.

Staffing: There appears to be sufficient staffing in the facility. CPR/First aid certificates are on file. Last Fire/Emergency Drill was 10/19/23.

Personnel Records-Training: All staff does have criminal record clearance. Staff files are maintained at the facility. Staff have current CPR/first aid training and documentation of ongoing training.

Client Rights-Information: Client personal rights poster is posted in the facility. Internet access is available for clients. No postural supports are used at facility.


Client Records-Incident Reports: Client files are kept within the facility and up to date.
Food Service: Meals are not provided at facility.
Health Related Services: No medications are administered at facility.
Incidental Medical Services: Facility is complying, no client with restricted health condition at facility.
Disaster Preparedness: The facility has an Emergency Disaster Plan at facility.
Emergency Intervention: Clients at this facility do not have restraints nor do they require the use of de-escalation techniques.

Deficiencies cited during today's visit.

An exit interview was conducted and a copy of this report and appeal rights were provided to Administrator.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
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