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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593695
Report Date: 03/03/2022
Date Signed: 03/03/2022 03:02:07 PM

Document Has Been Signed on 03/03/2022 03:02 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:CASA COLINA TLC/POST ACUTE BRAIN INJURY SERVICESFACILITY NUMBER:
191593695
ADMINISTRATOR:STEPHANIE KAPLANFACILITY TYPE:
775
ADDRESS:255 EAST BONITATELEPHONE:
(909) 596-0955
CITY:POMONASTATE: CAZIP CODE:
91769
CAPACITY: 24CENSUS: 24DATE:
03/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Stephanie Kaplan - AdministratorTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met with the Administrator Stephanie Kaplan and explained the reason for the visit. The facility is an Adult Day Program (ADP) licensed to accommodate 24 adults with Traumatic Brain Injuries (TBI). The program consists of 1 large single-story building. A tour of the single-story building included: lobby, several office rooms, 5 restrooms, large therapy/exercise room, kitchen area, gym, laundry room, and backyard.


LPA toured the facility with the Stephanie Kaplan (Administrator) and Linda Leyva (Director of Accreditation and Licensing), and the following was observed: the program site is clean, safe, sanitary and in good repair. All passageways are free from obstruction. Disinfectants, cleaning solutions and poisons are inaccessible to clients and are locked inside a closet. There are two fire extinguishers in the kitchen and hallway and are fully charged. The last fire drill was conducted on 02/26/2022. Facility has functioning smoke detectors and carbon monoxides throughout the building. The restrooms are well maintained and in good repair. The water temperature was tested in 3 out of the 5 restrooms and it measured at 105.3 degrees F, which is within the required 105-120 degrees F. There are no clients taking medication during programming hours. Food is not prepared at this program and clients are able to bring their own food. The kitchen area has a refrigerator where the clients can store their food. Staff and client files were not reviewed today. Facility has 30 days supplies of Personal Protective Equipment (PPE) in the laundry room. Facility is following COVID-19 recommendations regarding screening visitors, staff, and clients. COVID-19 prevention signs are posted throughout the facility and hand-washing signs were observed in the restrooms. Sufficient hand soap, hand sanitizer, and paper towels were observed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2022
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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