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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197801162
Report Date: 06/15/2023
Date Signed: 06/15/2023 03:40:26 PM

Document Has Been Signed on 06/15/2023 03:40 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:INDEPENDENT OPTIONS, INC./ADVANCED OPTIONS, S.G.FACILITY NUMBER:
197801162
ADMINISTRATOR:IRMA SWENSONFACILITY TYPE:
775
ADDRESS:603 W. COVINA BLVD.TELEPHONE:
(909) 394-3300
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY: 30CENSUS: 24DATE:
06/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Irma SwensonTIME COMPLETED:
03:49 PM
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Licensing Program Analyst (LPA) Alberto Lopez conducted the required annual inspection. LPA arrived unannounced and met with Staff Elizabeth Mendoza who allowed entry. Program Director Irma Swenson arrived a short time later and LAP discussed purpose for the visit. Facility currently services twenty-four (24) clients. Facility capacity is thirty (30) clients. The facility is licensed to serve twenty (20) non-ambulatory, which six (6) wheelchairs and four (4) walkers only. Clients are developmentally disabled adults, ages 18-65. The program is vendorized through San Gabriel/Pomona Regional Center. The facility hours of operation are Mon - Fri, from 08:00am -04:00pm. Clients attend programs at the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Fire extinguishers’ last service was in March 2022. First aid kit is fully stocked with all required items. Signages and mandated documents are posted.

Infection Control: The facility staff are using appropriate hand hygiene. Disposals of trash are done immediately. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan.
Operational Requirements: The facility has approved fire department clearance. The facility has enough liability insurance covering injury to residents and guest.

(Continue on 809C)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2023
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: INDEPENDENT OPTIONS, INC./ADVANCED OPTIONS, S.G.
FACILITY NUMBER: 197801162
VISIT DATE: 06/15/2023
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Physical Plant & Environment Safety: The facility is a single-story structure, has its own parking lot, consists of a reception, Program Director's office, two (2) restrooms, five (5) group rooms, kitchen, staff room, storage room, and exercise area. All rooms have required furniture and equipment necessary to conduct activities. The bathrooms are clean and operable. With exception of one shower drain. Hot water temperature measured at 115.3-116.3 degrees Fahrenheit. Disinfectants and cleaning solutions are locked and inaccessible to clients. Sharp knives and objects are locked and inaccessible to clients. Smoke detectors and carbon monoxide detectors are tested, operable and in compliance. No pools and bodies of water are found in or around the property. No storage of firearms/poisons or other dangerous weapons are present or kept in the facility.
Staffing: There appears to be sufficient staffing at the facility. Staffing requirement is maintained as specified by Regional Center
Personnel Records-Training: Staff files are maintained at the facility. Staff all have current CPR/first aid training and evidence of on-going training.
Client Records-Incident Reports: Client files are maintained at facility and have the required documents in their files.
Client Rights-Information: The Complaint poster and client personal rights are posted in each room throughout the facility.
Planned Activities: Facility has sufficient space to accommodate indoor activities. There are sufficient supplies and equipment to meet resident's physical capability.
Food Service: Meals are not provided at facility. Only snacks and they were stored with cleaning solutions.
Health related Services: All staff have current CPR/First aid training.
Incidental Medical & Dental: The facility does not keep or administer medications for clients.
Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites.
Emergency Intervention: does not apply.

During the visit today, LPA did not observe any deficiencies. Technical advisories were provided.

An exit interview was held. A copy of this report, technical advisory notes, and appeal rights were given to Program director Irma Swenson.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC809 (FAS) - (06/04)
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