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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191592837
Report Date: 02/24/2026
Date Signed: 02/25/2026 08:28:53 AM

Document Has Been Signed on 02/25/2026 08:28 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CLIMB WORK ACTIVITY CENTERFACILITY NUMBER:
191592837
ADMINISTRATOR/
DIRECTOR:		JANNELLE CANDACE PONCEFACILITY TYPE:
775
ADDRESS:161 SIERRA MADRE BLVDTELEPHONE:
(626) 355-1447
CITY:SIERRA MADRESTATE: CAZIP CODE:
91024
CAPACITY: 60CENSUS: 40DATE:
02/24/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Patricia Wong, Medical CoordinatorTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced required 1-year inspection. LPA met with Patricia Wong, Medical Coordinator and explained the purpose of the visit. Subash Thakuri, Day Program Manager arrived shortly after to help assist with the visit. The adult day program is licensed to serve developmentally disabled-legally blind clients ages 18-59 years old, approved for (5) non-ambulatory and (55) ambulatory consumers only. Hours of operation are 9am-3pm, Monday-Friday. Services provided by San Gabriel Pomona Regional Center.

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 cleaning/disinfecting throughout the day. Facility has sufficient PPE supplies. Based on record review, LPA observed that the facility has an Infection Control Plan in place.

Physical Plant & Environment Safety: This is a single-story facility located in Sierra Madre, CA. A tour of the facility includes: reception area two (2) large activity rooms, one (1) workshop room, one (1) production room, kitchen, and two (2) restrooms. Bathroom #1 has a faucet, toilet, and a showerhead. Bathroom #2 only has a faucet and toilet. Facility walls and floors were in good condition and adequate lighting. Carbon monoxide detectors are operable and working properly. LPA observed one (1) fire extinguisher that was fully charged and last inspected on 04/15/2025. No bodies of water were observed at the facility. All toilets and hand-washing facilities were well maintained, safe, sanitary and in operating condition.

[Continue to LIC809-C]

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 02/25/2026 08:28 AM - It Cannot Be Edited


Created By: Daniel Konishi On 02/24/2026 at 02:54 PM
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: CLIMB WORK ACTIVITY CENTER
FACILITY NUMBER: 191592837

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, LPA tested the hot water temperature in bathroom #1 at 87.2 and bathroom #2 at 87.0 degrees F which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2026
Plan of Correction
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Administrator shall immediately adjust water temperature. Administrator to check water temperature at various different times throughout the day and maintain and submit a water temperature log to the LPA for the next 3 days to ensure that hot water temperature falls within 105 degree F and 120 degrees F. Administrator will provide a copy of the log to the department once water temperature falls within Title 22 guidelines.
Type B
Section Cited
CCR
82068(a)
Admission Agreements
(a) The licensee shall complete and maintain an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA observed Client #6 (C6), Client #7 (C7), and Client #8 (C8's) file did not have a Admission Agreement which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2026
Plan of Correction
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The Administrator will send Client #6 (C6), Client #7 (C7), and Client #8 (C8's) copy of Admission Agreement to the LPA by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
David Sicairos
NAME OF LICENSING PROGRAM MANAGER:
Daniel Konishi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2026


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 02/25/2026 08:28 AM - It Cannot Be Edited


Created By: Daniel Konishi On 02/24/2026 at 02:54 PM
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: CLIMB WORK ACTIVITY CENTER
FACILITY NUMBER: 191592837

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068.2(d)(1)
Needs and Services Plan
(d) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: (1) The needs appraisal or IPP is not more than one year old.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA observed Client #8 (C8’s) file had a Individual program plan (IPP) dated 11/10/2022 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2026
Plan of Correction
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Administrator will send Client #8 (C8's) current Invideual program plan (IPP) to the LPA by the POC due date.
Type B
Section Cited
CCR
82068.2(f)(1)(B)
Needs and Services Plan
(f) The completed Needs and Services Plan shall include: (1) The client's desires and background and formal supports, obtained from the client's family or his/her authorized representative, if any, regarding the following: (B) A written medical assessment including primary physician, health problems and medical history, prescribed medications and their strength, quantity, frequency required and purpose as specified in Section 82069(b)(3).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA observed Client #7 (C7) and Client #8 (C8’s) file did not have a Medical Assessment which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2026
Plan of Correction
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Administrator will send Client #7 (C7) and Client #8 (C8's) complete Medical Assessment to the LPA by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
David Sicairos
NAME OF LICENSING PROGRAM MANAGER:
Daniel Konishi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2026


LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CLIMB WORK ACTIVITY CENTER
FACILITY NUMBER: 191592837
VISIT DATE: 02/24/2026
NARRATIVE
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Physical Plant & Environment Safety [Cont]: LPA tested the hot water temperature in bathroom #1 at 87.2 and bathroom #2 at 87.0 degrees F which are not within Title 22 Regulations of 105 degrees F to 120 degrees F. All storage areas for cleaning solutions, toxins, poisons and hazardous items are stored in a secured/locked storage room and inaccessible to clients.

Operational Requirements: The facility has the appropriate fire clearance. Staff are knowledgeable on their reporting requirements.

Staffing: There appears to be sufficient staffing in the facility. There are at least fifteen (15) staff members on duty any time there are clients in the facility. Per Staff #1 (S1), the staff to client ratio is one (1) caregiver to three (3) consumers.

Personnel Records-Training: LPA reviewed six (6) staff files that include Personnel Record/Job Application, Health Screening, TB clearance, Employee Rights, Valid First Aid/CPR Training, and Staff training. The Administrator’s Certificate is valid and expires on 06/03/2026.

Client Records-Incident Reports: Client files are kept in a secure location within the staff office and LPA reviewed five (5) client files which includes the face sheet, Identification and Emergency Information, Admission Agreement, Personal Rights, Physician's Report, Ambulatory Status, TB clearance, and a current IPP (Individual Program Plan). Based on record review, LPA observed Client #6 (C6) to Client #8 (C8’s) file did not have a Admission Agreement. Based on record review, LPA observed Client #7 (C7) and C8’s file did not have a complete Medical Assessment. Based on record review, LPA observed C8’s file had a IPP dated 11/10/2022.

Client Rights-Information: Client Rights Poster is posted within the large activity room.

Food Service: The kitchen was inspected and the food preparation area and storage areas were observed to be clean and sanitary. Refrigerators are available for client use to store their lunches. The program does not provide lunch. The kitchen has a stove but knobs were removed for safety purposes. Pesticides and other similar toxic substances are not stored in food storage rooms or other kitchen areas.

Health Related Services: LPA reviewed five (5) client medications. Medications are administered as prescribed. Medications are centrally stored and locked. Facility staff have an updated first aid certificate and they have at least one staff able to perform CPR. LPA observed the First Aid Kit which had all required items.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CLIMB WORK ACTIVITY CENTER
FACILITY NUMBER: 191592837
VISIT DATE: 02/24/2026
NARRATIVE
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Incidental Medical & Dental: Staff have proper training and training is documented within the personnel files. Based on record review, LPA observed there is one (1) client who have a restricted health condition and the facility has a updated Restricted Health Care Plan.

Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least two (2) relocation sites. Evacuation Procedures are in the facility’s Health and Safety file. The last Fire Drill was conducted on 10/28/2025.

Emergency Intervention: The Facility does not use any restraints or seclusion on clients. Clients at this facility do not require the use de-escalation techniques.

Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies observed during today’s visit will be documented on the LIC809-D. Exit interview was held and a copy of the report and appeal rights were provided to the Administrator, Hector Vargas.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC809 (FAS) - (06/04)
Page: 6 of 6