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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197601249
Report Date: 09/11/2023
Date Signed: 09/11/2023 01:29:42 PM

Document Has Been Signed on 09/11/2023 01:29 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
Lookup Error,
, CA
FACILITY NAME:ADULT BASIC LEARNING ENVIRONMENT, INCFACILITY NUMBER:
197601249
ADMINISTRATOR:ROBERT MARTINEZFACILITY TYPE:
775
ADDRESS:204 N. VICTORY BLVD.TELEPHONE:
(818) 842-4933
CITY:BURBANKSTATE: CAZIP CODE:
91502
CAPACITY: 30CENSUS: 9DATE:
09/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Sheri Glendenning - DirectorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year inspection. LPA Pena was met by the Program Director, Sheri Glendenning and Designated Staff, Maryland Delgado and explained the purpose of today's visit. The facility is a freestanding building, an office type property within the city of Burbank. It is licensed to serve clients age range 18 and over, 30 non-ambulatory. All clients at the program receive case management services provided by Frank D. Lanterman Regional Center. The day program site consists of a lobby area, three (3) activity rooms divided into various work areas such as; Life/Vocational Skills area, entertainment/music room and arts & crafts room, two (2) all-gender restrooms, one of which is also used as a changing/first-aid room, relaxation/meditation room, storage room, break room/kitchen, client storage lockers (18) and staff office.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and the following was inspected:

Infection Control:
  • Infection control practices and Personal Protective Equipment (PPEs) were observed.
  • There is a visitor sign-in station and PPE supplies located near the front door.
  • The staff stated that disposable gloves are used to clean and disinfect the high touched surfaces in the common areas.
  • The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan through the Regional Center.
  • Staff are adhering to infection control requirements.
Physical Plant & Environment Safety:
  • The program site has a universal screening area located in the entrance.
  • There was COVID-19 signage placed at the entrance door.
  • Smoke detectors/carbon monoxide detectors are in compliance and operational.
  • The program site has sufficient supply of PPEs such as masks, gloves and hand sanitizers.
  • There are eighteen (18) lockers available for clients use, located outside the kitchen/break room.
  • The program site provides media room and computer room for clients' use.
  • There is a relaxation room for rest periods available to clients and staff. However, LPA observed that the room is not enclosed and no glass on the windows. Director stated that they were removed for safety reasons.
  • Cleaning supplies and other toxic materials were stored and kept locked in the chemical room.
  • There is a supply/storage room to house the PPE supplies which was locked and inaccessible to clients.
  • Hot water temperature was measured in the restrooms and read at 118.0 deg F and 117.3 deg F which was within the required 105-120 degrees F.
  • There were four (4) fire extinguishers in the facility observed to be fully charged and last serviced on 11/10/2022.
  • LPA observed sharp objects in a locked cabinet located in one of the staff office.
  • Doors, exits, hallways, and passageways were clear and free of obstruction.
  • The front yard/parking area was observed to be clean and free of debris.
  • No pools or bodies of water were observed in or around the building.
  • There are no firearms present at the facility.
  • The program site did not have a video camera monitor system inside or outside the building.

***CONTINUED ON LIC 809-C****
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2023
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
Lookup Error,
, CA
FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC
FACILITY NUMBER: 197601249
VISIT DATE: 09/11/2023
NARRATIVE
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Operational Requirements:
  • A current Plan of Operation was reviewed.
  • Liability Insurance is in place and expires 7/08/2024.
  • The program has a computer room, and provides one (1) IPad and two (2) tablets for clients use.
  • The program site does not handle clients' cash resources.
  • An operating telephone was observed to be easily accessible and available for clients' use.
Personnel Records-Training:
  • Criminal Record clearances/exemptions are maintained at the program site.
  • Three (3) Staff files were reviewed; two (2) staff did not have first aid/CPR on file and two (2) staff did not have medical assessment/ health screening on file.
  • A plan of coverage in absence of the Director is in place, the Program Director will step-in her absence, and vice versa.
  • The last fire drill was completed in August 2023.
Client Records-Incident Reports:
  • LPA reviewed three (3) client files that were maintained at the facility. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, Individual Program Plan (IPP), Behavioral Reports, and Personal Rights observed.
Client Rights-Information:
  • The program site has adequate furnishings and equipment to meet the clients' needs.
  • Visitors policy was observed posted in the workspace area accessible to clients and their visitors.
  • Client personal rights are posted.
  • Facility provides internet services to all clients and have access to the facility phone. Facility provides one (1) IPad and two (2) tablets to the clients.
  • LPA conducted three (3) client interviews.
Food Service:
  • This day program does not serve meals but clients are welcome to bring their own lunch and warm the food in the kitchen if they prefer.
  • Food storage and preparation areas, which include pantries, cupboards, drawers and counters were observed to be clean and appropriate for food preparation. Appliances such as a microwave, refrigerator and stove were observed to be clean and operating properly.
  • The program runs daily (Mon-Fri) from 8am-2:30pm
  • The refrigerator was observed to be at 45 degrees Fahrenheit and the freezer at 0 degrees Fahrenheit.
Health Related Services:
  • First Aid supply kit was observed and is kept in a locked cabinet in the lobby area which included all required supplies.
  • List of emergency contacts such as Police, Fire Dept. or paramedic unit was reviewed. The program site has one medical resource available to be called at all times.
  • Currently, none of the clients require assistance with medications and none take medications while attending the program. Medications were to be stored and locked in the Staff office.
Disaster Preparedness:
  • The facility has a complete Emergency and Disaster Preparedness Plan that includes, EVAC Procedures, Transportation arrangements, Location of all utility shut-off valves and instructions for use.
  • The program has a contact information list of local emergency response personnel, clients authorized representative or local emergency contact name.

Deficiencies were cited.

Exit interview conducted and a copy of this report and appeals rights were provided to the Director, Sheri Glendenning.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/11/2023 01:29 PM - It Cannot Be Edited


Created By: Bennette Pena On 09/11/2023 at 12:59 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
,
, CA

FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC
FACILITY NUMBER: 197601249

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82065(g)(1)
Personnel Requirements
(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
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Based on record review, the Director did not comply with the section cited above in that there was no evidence of a medical assessment/health screening on file for Staff #2 (S2) and Staff #3 (S3) which poses/posed a potential health, safety or personal rights risk to clients in care.
POC Due Date: 09/25/2023
Plan of Correction
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Director will ensure that all staff have proof of current health screening on file and to have Staff #2 and Staff #3 complete a test for health screening and submit proof of correction to CCLD/LPA by POC due date.
Type B
Section Cited
CCR
82075(f)
Health-Related Services
(f) Staff responsible for providing direct care and supervision shall receive and maintain current training in first aid and cardiopulmonary resuscitation from persons qualified by agencies including, but not limited to, the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the Director did not comply with the section cited above in in that 2 out of 3 staff files reviewed (Staff #1 & Staff #2) did not have First Aid/CPR training on file which poses/posed a potential health, safety or personal rights risk to clients in care.
POC Due Date: 09/25/2023
Plan of Correction
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Director shall obtain current first aid/CPR training for Staff #1 and Staff #2 and provide proof of training completion to CCLD/LPA by 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.
SUPERVISOR'S NAME:David Sicairos
LICENSING EVALUATOR NAME:Bennette Pena
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2023


LIC809 (FAS) - (06/04)
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