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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603293
Report Date: 05/16/2024
Date Signed: 05/16/2024 12:27:16 PM

Document Has Been Signed on 05/16/2024 12:27 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, INC.FACILITY NUMBER:
197603293
ADMINISTRATOR/
DIRECTOR:		RUNTU, RAMAMITAFACILITY TYPE:
775
ADDRESS:320 WEST COLORADO BLVD.TELEPHONE:
(818) 550-8400
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 45CENSUS: 13DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Program Director Sheri GlendenningTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Jose Villalobos conducted the unannounced Annual Inspection visit using the Compliance And Regulatory Enforcement (CARE) Tool. LPA met with Program Director Sheri Glendenning and the purpose of the visit was discussed. The following tool domains were completed:

Infection Control: LPA observed the facility has sufficient PPE supplies. Infection Control Plan is in place. The plan was collected and reviewed.

Physical Plant and Environmental Safety: The facility is fire cleared to provide services to forty-five (45) non-ambulatory clients. The facility is currently providing services to thirteen (13) clients. Facility is located in a commercial area and consist of a large activity room segmented into (3) activity areas, a kitchen, dining area, relax room, Office room, and 2 restrooms for clients. The facility was inspected during the physical plant tour. No passageways or paths were obstructed.

Operational Requirements: Facility is operating within its approved clearance.

Staffing: The facility has a sufficient staffing in place to meet Staff-Client Ratio.

Personnel Records-Training: Personal records centrally stored. LPA inspected five (5) staff files. All staff are fingerprint cleared but (3) staff missing documentation on file. (3) staff files reviewed also missing health screening documentation.

Client's Right - Information: Postural support documentation observed. Required postings observed.

Continued on LIC 809-C
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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 05/16/2024 12:27 PM - It Cannot Be Edited


Created By: Jose Villalobos On 05/16/2024 at 11:55 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
,
, CA

FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC.
FACILITY NUMBER: 197603293

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82066(a)(10)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (10) A health screening, as specified in Section 82065(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as (3) of (5) Staff files reviewed did not have a health screening documenation on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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Facility to provide LPA copies of the health screening for the (3) of (5) Staff by POC due date.
Type B
Section Cited
CCR
82066(a)(12)(B)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (12) For employees that are required to be fingerprinted pursuant to Section 82019(a): (B) Documentation of either a criminal record clearance or exemption as required by Section 82019(e).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as (3) of (5) Staff files reviewed did not have criminal record clearance documentation on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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Facility to collect criminal record clearance documents to keep on file and provide LPA Villalobos copies 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:Fernando Fierros
LICENSING EVALUATOR NAME:Jose Villalobos
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


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: 197603293
VISIT DATE: 05/16/2024
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Food Service: Clients bring their own meals to eat at the day program. Pesticides and other toxic substances were not stored with the food supply. Kitchen area was clean.

Client Records/Incident Reports: Client files are centrally stored. LPA reviewed four (4) client files. Client files are up to date and have required documents.

Health Related Services: No medication management is provided currently at the day program. LPA did not observe any medications.

Incidental Medical Services: Restricted health condition plans observed on file. There are no clients in care with prohibited or restricted health conditions. First Aid kid observed and available when needed.

Disaster preparedness: The facility has an updated emergency disaster plan. The plan was reviewed. Facility has client information readily available in case of emergencies.

Emergency Intervention: The facility are not using any restraints in the facility.

Per Title 22 Regulations, deficiencies are being cited on todays visit. Please 809-D for details.

Exit Interview conducted. Appeal rights discussed. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
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