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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593365
Report Date: 02/27/2024
Date Signed: 02/27/2024 12:29:16 PM

Document Has Been Signed on 02/27/2024 12:29 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:CLIMB WORK ACTIVITY CENTER-ALHAMBRAFACILITY NUMBER:
191593365
ADMINISTRATOR:ACABAL, MARILYNFACILITY TYPE:
775
ADDRESS:2300 WEST MAIN ST.TELEPHONE:
(626) 289-5321
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY: 50CENSUS: 30DATE:
02/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:34 AM
MET WITH:Evelyn Brindis and John Nguyen, AdministratorTIME COMPLETED:
12:36 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required-1 year visit. . LPA met with Sheryl Barnardo who allowed entry and Administrator John Nguyen arrived a short time later. LPA explained the purpose of today's visit. There are (4) clients on-site. (54) are community based. This program provides services for developmentally disabled clients (ages 18-59) from various Regional Centers. Currently, there are (47) clients from Eastern Los Angeles Regional Center, (2) clients from Frank D. Lanterman Regional Center and (5) from San Gabriel Pomona Regional Center.

This facility consists of: One sensory motor room (detached building), (5) bathrooms, (2) activity room, (2) designated rooms for clients experiencing symptoms (awaiting for pick up) and administrative offices.
The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical Services, Disaster Preparedness, and Emergency Intervention.

There are no obstructions to the walkways nor any bodies of water.
The facility is undergoing construction and facility will need to formally notify the department.
* The day program does utilize sharp scissors and are accessible to clients.
* Hand sanitizers are readily available around the facility and adequate PPE supplies were observed.
* LPA Lopez observed disinfectants, cleaning solutions, locked and inaccessible to clients.
* The hot water temperature is measured between 98.0 148.1 - degrees F, which is not within range.
* The fire extinguishers were inspected and fully charged.
* Last Fire Drill conducted 02/07/2024.
* The day program has the smoke/carbon monoxide detectors in each room.
* Clients bring their own food to day program; staff warm up food in microwave.
* First Aid kit contains the required items.
* The day program does not administer medication to clients.
* Day program has a total of (14) transportation vehicles.

Deficiencies was cited on LIC 809D. Exit interview conducted and a copy of this report and appeal rights were given.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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 02/27/2024 12:29 PM - It Cannot Be Edited


Created By: Alberto Lopez On 02/27/2024 at 11:57 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: CLIMB WORK ACTIVITY CENTER-ALHAMBRA
FACILITY NUMBER: 191593365

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)
Buildings and Grounds
(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. There is water damage in one room which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/26/2024
Plan of Correction
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Facility will repair the water damage and send proof to LPA by POC date.
Type A
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(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. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

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. 2 sharp scissors were accessible to clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2024
Plan of Correction
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Licensee will remove and lock the scissors and make them inaccessible to clients and send proof to LPA by POC 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.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/27/2024 12:29 PM - It Cannot Be Edited


Created By: Alberto Lopez On 02/27/2024 at 11:57 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: CLIMB WORK ACTIVITY CENTER-ALHAMBRA
FACILITY NUMBER: 191593365

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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 observatio, the licensee did not comply with the section cited above, water was measured between 98-.0 - 148.1 degrees F which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2024
Plan of Correction
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Licensee will adjust water and keep a log for 7 days and send to LPA as proof 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: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4