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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197801934
Report Date: 09/20/2021
Date Signed: 09/20/2021 12:35:23 PM

Document Has Been Signed on 09/20/2021 12:35 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:COLE VOCATIONAL SERVICES COVINA 2FACILITY NUMBER:
197801934
ADMINISTRATOR:MATT PORPORAFACILITY TYPE:
775
ADDRESS:515 S 2ND AVETELEPHONE:
(626) 915-6678
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 45CENSUS: 36DATE:
09/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Miriam Maldonado, Program DirectorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Tao conducted a required unannounced annual visit and met with Miriam Maldonado, Program Director who was explained the nature of today’s visit. The facility is licensed to serve twenty (20) ambulatory and twenty-five (25) non-Ambulatory clients, age range 18 and 65. Client census is thirty-six (36) clients. Facility capacity is forty-five (45) clients. The program is vendorized through the San Gabriel/Pomona Regional Center. The facility hours of operation are Monday through Friday from 10:00-4:00pm. Miriam explained that clients are doing remote learning since 2020 due to Covid pandemic. No clients are present at the facility.

During the visit, the infection control domain tool was used, a tour of the facility was conducted and food supply was reviewed. Medications were not reviewed since facility did not handle medication. Facility only provides snacks. No meal is served at the day program.

The facility is a single story structure, has its own parking lot, consists of reception near Program Supervisor and Program Director's office, three (3) restrooms, a Fitness Room, Hobby Room, Tech Lounge, Zen Room (Relaxation), Music room, Lobby/Reception room, Art Studio, Hash House, Changing Room, Theater, locker area, and small indoor/outdoor activity area. All rooms have required furniture and equipment necessary to conduct all activities. The bathrooms are clean and operational. Disinfectants and cleaning solutions are locked and inaccessible to clients. The hot water temperature measured at 105.6 degrees Fahrenheit. Smoke detectors are hard wired. Carbon monoxide detector is 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. Fire extinguishers’ last service is on 10/10/2020 and are fully chagred. First aid kit is fully stocked with all required items. Signages and mandated documents are posted. Sharp knives and objects are locked and inaccessible to clients.

No deficiencies noted at the time of visit. Exit interview was conducted and report was provided to Miriam.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2021
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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