197801689-6-13-2023-28-AS-CWOG-CSRUUU-20230613155408

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197801689
Report Date: 06/13/2023
Date Signed: 06/13/2023 04:46:45 PM

Document Has Been Signed on 06/13/2023 04:46 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	FIRST CHANCE FOR THE DEVELOPMENTALLY DISABLED		FACILITY NUMBER:	197801689
ADMINISTRATOR:	TAMARU FRANCIS		FACILITY TYPE:	735
ADDRESS:	715 E. CHESTER ROAD		TELEPHONE:	(626) 858-1803
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY: 6		CENSUS: 6	DATE:	06/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:32 PM
MET WITH:	TAMARU FRANCIS		TIME COMPLETED:	04:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with the administrator Tamaru Francis and allowed the entry of the visit and assisted with today's visit. The purpose for the visit was explained. The facility is licensed and APPROVED FOR 6 AMBULATORY CLIENTS, AGES 18-59. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and inspected those domain: 1. Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting at least once a day and more often for high touched surfaces area. Facility has sufficient PPE supplies and has an Infection Control Plan. 2. Physical Plant and Environmental: The facility is a single story house and its located in a residential neighborhood area. The facility includes: kitchen, dining area, living room, three clients bedrooms, two bathrooms and a detached garage. There shall be no more than two clients per bedroom. Each bedrooms has two beds, two chairs, two night stands, two drawers, required beddings, sufficient lighting and closet space. The bathrooms is clean, sanitary and in an operable condition. The hot water temperature in two bathrooms were tested between 111.7 and 112.2 degrees F which is within the title 22 regulation. All the clients room are maintained within the required temperature. All the cleaning supplies and chemicals are stored and locked in the storage room near the dining area. The facility has ample supply of personal hygiene products for clients to use. All the sharp knives and utensils are stored in the medication cabinet in the kitchen area. The extra linen are stored in the hallway cabinet. LPA inspected the smoke detectors and carbon monoxide detectors and they are all working well.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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: FIRST CHANCE FOR THE DEVELOPMENTALLY DISABLED	FACILITY NUMBER: 197801689
	VISIT DATE: 06/13/2023

NARRATIVE

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3. Operational Requirements: The facility is approved for 6 ambulatory clients only and currently all 6 clients are ambulatory. The last fire and earth quake drill were conducted on May, 2023. The facility also has shaded area with table and chairs for client to utilize for outdoor activity.

4. Staffing: The facility has sufficient staffing to provide care and supervision to the clients. The night supervision staff does have the required training on planned emergency procedures.

5. Personnel Record: All the staff files are stored and maintained in the facility. All staff are over 18 years of age and fingerprinted and associated with the facility and have the TB and health screening. All staff also has an updated First Aid Certificate. The facility administrator is Tamara Francis and her administrator certificate will be expired on 12/2/23 and she also has updated training with HIV /TB.

6. Client's Right-Information: Currently the facility does not have any clients with postural support. The facility also provide clients for at least one internet access devices include tablets, computer, smart phone ..etc.

7. Client Records-Incident Reports- All clients files are stored in the staff office and maintained in the facility. All clients files has all required documents including face sheet, physician report with the ambulatory status, admission agreement, Individual Personalized Plan (IPP) and the updated medication list.

8. Food Services: The facility has two days perishable and seven days non-perishable food supply. The refrigerator is maintained in the required temperature. All the food are stored probably.

9. Health Related Services: All the clients medication are centrally stored in the medication cabinet near the kitchen area. LPA inspected all 6 clients medication and they are all seemed updated and accurate. All the staff also has medication management training.

10. Incidental Medical Services: Currently Facility does not have client with prohibited health condition or restricted health condition

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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: FIRST CHANCE FOR THE DEVELOPMENTALLY DISABLED	FACILITY NUMBER: 197801689
	VISIT DATE: 06/13/2023

NARRATIVE

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11. Disaster Preparedness: The facility has an updated emergency disaster plan dated on 6/13/23 and posted on the post board in the staff office and there are two alternative emergency locations.

12. Emergency Intervention: All the staff have an updated Pro-Act Training.

No deficiencies were observed during the visit

Exit Interview conducted and a copy of the report was provided to Administrator Tamaru Francis.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC809 (FAS) - (06/04)

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