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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197801934
Report Date: 11/10/2022
Date Signed: 11/10/2022 12:12:51 PM

Document Has Been Signed on 11/10/2022 12:12 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: 17DATE:
11/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Andres (Andy) Garcia TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual visit at the facility. LPA met with Andres (Andy) Garcia - Day Program Manager and explained the reason for the visit.

Facility is licensed to serve 45 clients FACILITY IS CLEARED FOR 25 NON-AMBULATORY/WHEEL CHAIR CLIENTS. CLIENTS ARE DEVELOPMENTALLY DISABLED AGES 18 - 65. Facility serves an adult day program capacity and is currently serving clients virtually and in person due to COVID 19. Facility has a program director office, art studio, kitchen, reception area, music room, tech lounge, changing room with clients lockers, theater room, storage room, fitness room, supervisor office, three clients/staff bathrooms.

LPA conducted a tour of the facility with the day program manager and observed the following:
Restrooms water temperature were tested between 72 degrees F and 112 degrees F which is not within the 105 - 120 degrees F. Facility has a fire sprinkle system, and 4 fire extinguishers were observed throughout the facility. Facility has 2 first aid kits: 1 in the program director office and 1 in the receptionist area which contains the required items. All the sharp knives are locked in the drawer in the program director office. LPA also inspected carbon monoxide detectors and they are working properly.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, social distancing by allowing a number of people in each room, disinfecting products are available in each room and facility is disinfected everyday ,Restrooms have sufficient soap, paper towels, and signs, PPE supplies are sufficient for more than 30 days.

Pursuant to Title 22, deficiencies were cited on attached 809D. An exit interview was conducted and a copy of this report and Appeal Rights were provided to the Day Program Manger Andres (Andy) Garcia.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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 11/10/2022 12:12 PM - It Cannot Be Edited


Created By: Christine Wong On 11/10/2022 at 11:18 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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: COLE VOCATIONAL SERVICES COVINA 2
FACILITY NUMBER: 197801934

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82088(e)(1)
82088 Fixtures, Furniture, Equipment and Supplies (e) Faucets used by clients for personal care shall deliver hot water.
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, LPA observed Bathroom#1 and #3, the hot water was tested between 72 and 80 degrees F. which posted an immediate risk to clients in care.
POC Due Date: 11/11/2022
Plan of Correction
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The administrator will ensure the hot water temperature of not less than 105 degrees F and not more than 120 degrees F and the administrator will fixed immediately the hot water temperature and then send the 7 consectuive hot water log to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Christine Yee
LICENSING EVALUATOR NAME:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022


LIC809 (FAS) - (06/04)
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