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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191592637
Report Date: 02/08/2022
Date Signed: 02/08/2022 01:26:36 PM

Document Has Been Signed on 02/08/2022 01:26 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:ADULT BASIC LEARNING ENVIRONMENT, INC.FACILITY NUMBER:
191592637
ADMINISTRATOR:MICHAEL MORALESFACILITY TYPE:
775
ADDRESS:452 W. BADILLO ST.TELEPHONE:
(626) 858-5267
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 30CENSUS: 0DATE:
02/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Miriam Cuevas, Program DirectorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Tao conducted a required annual visit and met with Program Director, Miriam Cuevas, who was explained the reason for the visit. The day program is licensed for 30 non-ambulatory Developmentally Disabled Adults, age 18 through 59. The facility is permitted for 13 wheelchairs. Miriam explained that they have 15 clients on roster and they are doing remote learning since 2020 due to Covid pandemic.

During the visit, the infection control domain tool was used, a tour of the facility was conducted and food supply was reviewed. Medications were not reviewed since facility did not provide assistance with medications. Facility only provided snacks. Since no clients was attending services at the facility, no snack was observed. No meal was served at the day program.

The facility is a single story facility located in a residential neighborhood. The day program was toured was observed to be operating within the approved capacity. The facility consists of a Vocational room, Relaxation room, Arts/Crafts room, multipurpose room/ lobby, changing room, program director office, kitchen and three (3) restrooms. Water temperature in the kitchen is measured at 111.5 degrees Fahrenheit which is within the required range of 105 - 120 degrees. The restrooms were observed to be clean and operable. Facility smoke detectors and carbon monoxide devices are operable. Three (3) fire extinguishers were fully charged. First aid kit is fully stocked with required items.

(- continued in LIC 809 C-)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2022
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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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. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC.
FACILITY NUMBER: 191592637
VISIT DATE: 02/08/2022
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Cleaning supplies and other toxins were locked in a storage room. The kitchen area was toured. Kitchen had a sink, refrigerator, and microwave. Appliances were operating at the time of the visit. Signages and mandated documents were posted. Sharp knives and objects were locked and inaccessible to clients. Snack was not observed but the snack storage was safe and in a healthful manner.

Disinfectants and cleaning supplies were stored in locked cabinets. The activity rooms were observed to be safe for consumers and did not have any sharp objects or toxic chemicals. There was sufficient staff on the roster and all program were providing virtually and clients were involved in activities remotely.

Disaster drills were reviewed. The program documents the drills as required. The program does not transport consumers, therefore vehicles were not inspected.

Per California Code of Regulation, Title 22 and California Health and Safety Code, there were no deficiencies observed during the visit.

Exit interview held. A copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
LIC809 (FAS) - (06/04)
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