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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570600
Report Date: 06/22/2022
Date Signed: 06/22/2022 02:04:38 PM

Document Has Been Signed on 06/22/2022 02:04 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:DELHAVEN FAIRGROVE DAY LEARNING CENTERFACILITY NUMBER:
191570600
ADMINISTRATOR:SEAL, BOBBIEFACILITY TYPE:
775
ADDRESS:15145 FAIRGROVE AVE.TELEPHONE:
(626) 917-9789
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 60CENSUS: 22DATE:
06/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Tim Seal (Executive Director) TIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Kruz Long conducted an unannounced annual inspection at the facility. Upon arrival, LPA met with Tim Seal (Executive Director) and explained the purpose of the visit. LICENSEE PREFERS TO SERVE DEVELOPMENTALLY DISABLED CLIENTS AGES 18 TO 59 YEARS. CLEARED FOR 56 AMBULATORY & 4 NON-AMBULATORY CLEARED. HOURS MON.-FRI. 9AM-4PM.

The single story facility contains the following: 2 Activity rooms, office, break room, quarantine room, staff restroom, men's restroom and women's restroom.

During today's inspection, LPA observed the following: Licensee is not operating beyond the conditions and limitations specified on the license, including the capacity limitation. Motor vehicles used to transport clients is maintained in a safe operating condition. All clients are protected against hazards within the program site. Disinfectants, cleaning solutions, poisons are locked and inaccessible to clients. The licensee provides a separate room for use by ill client. Hot water temperature measured at 118.8 degrees F in the men's restroom. All toilets and hand washing basin is maintained in a safe, sanitary, operating condition. Smoke detectors and Carbon monoxide detector are operable. Clients provide their own meals. The licensee does provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement. The licensee ensures that clients are kept clean and dry and the day program remains free of odors. Program personnel is sufficient in numbers to provide the services necessary to meet individual client needs. The written Needs and Services Plan is maintained in the client's file. Staff subject to a criminal record has a clearance. Disaster drills was conducted within the last 6 months. Staff responsible for direct care and supervision have current First Aid and CPR. The administrator is at the program site the number of hours necessary to manage and administer the program.

No deficiencies were observed during today's visit.
An exit interview was conducted with Eric Benavidas and a copy of this report provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2022
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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