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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197601249
Report Date: 10/29/2024
Date Signed: 10/29/2024 03:46:59 PM

Document Has Been Signed on 10/29/2024 03:46 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ADULT BASIC LEARNING ENVIRONMENT, INCFACILITY NUMBER:
197601249
ADMINISTRATOR/
DIRECTOR:		ROBERT MARTINEZFACILITY TYPE:
775
ADDRESS:204 N. VICTORY BLVD.TELEPHONE:
(818) 842-4933
CITY:BURBANKSTATE: CAZIP CODE:
91502
CAPACITY: 30CENSUS: 12DATE:
10/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Director, Sheri GlendenningTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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This Case Management visit is conducted in conjunction with complaint investigation to address the deficiencies unrelated to the complaint has nothing to do with complaint visit.

During Complaint Investigation, LPA Alvizar-Ettima discovered the following Part-Time Staff (S1) and (S2) have been present without a Criminal Background Clearance and Association to this facility. S1 job title is Direct Support Professional (DSP), first day of work was 10/10/2023. S2 job title is Direct Support Professional (DSP), first day of work was 09/10/2024. LPA requested S1, S2 facility file folder and Director Glendenning provided it. At approximately 11:30a.m. via-phone LPM Naira Margaryan, Executive Director Cindi Raimondi met with Director and LPA in the Program Director's office and discussed S1's Criminal Record Exemption Needed dated 06/24/2024.

LPA verified using Facility Personnel Report Summary, staff S1 and S2 names did not appeared on facility roster.


S1- Andrew Mayes DOB: 03/26/1979
S2 – Nikol Michelle Byrne DOB: 10/31/1984


A citation and civil penalty were issued and recorded on LIC809D. Copy of this report was provide to Director, Sheri Glendenning.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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 2
Document Has Been Signed on 10/29/2024 03:46 PM - It Cannot Be Edited


Created By: Antonia Alvizar-Ettima On 10/29/2024 at 02:29 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
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/30/2024
Section Cited
CCR
82019(e)(2)

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82019(e)(2) Criminal Record Clearance (e)Prior to working.. in a licensed day program, all individuals subject to a criminal record review... shall do the following:(2)Obtain a California clearance or a criminal record exemption as required by the Department
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The Director has agree to the following:
Staff S1's last day is today and he will not be returning otherwise he will need to be background clearance and associated.

Director cleared POC today by escording S1 out of the faciltiy.
Type A
10/30/2024
Section Cited
CCR
82019(e)(3)

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82019(e)(3) Criminal Record Clearance (e)Prior to working.. in a licensed day program, all individuals subject to a criminal record review... shall do the following: (3) Request the licensee or applicant for a license to request a transfer of a criminal record clearance...
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The Director has agree to the following:
Staff S2's last day is today and they will not be returning otherwise she will need to be associated.

Director will provide proof of association for S2 by the POC date
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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:Naira Margaryan
LICENSING EVALUATOR NAME:Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2024


LIC809 (FAS) - (06/04)
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