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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197801934
Report Date: 10/19/2023
Date Signed: 10/19/2023 12:59:33 PM

Document Has Been Signed on 10/19/2023 12:59 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: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: 40DATE:
10/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH: Miriam Maldonado TIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual inspection at the facility. LPA met with Program Director Miriam Maldonado who allowed the entry of the facility and explained the purpose of the visit and assisted with LPA's visit today. The facility is cleared for 25 non-ambulatory/wheelchair clients. Hours of operation are 10am to 4pm, clients are developmentally disabled ages 18-65.

LPA utilized the Compliance and Regulatory Enforcement (CARE) Tools which contain the following domains: Infection Control, Physical Plant & Environment Safety, Operational Requirements, Staffing, Personnel Reports-Training, Client Rights - Information, Client Records-Incident Report, Food Services, Health Related Services, Incidental Medical Services, Disaster Preparedness, Emergency Intervention

The following were observed:
The day program is located in the suite of office building which include kitchen, art room, program director office, reception area, three unisex bathrooms, music room, quality care room (Quiet room), computer room, changing room, theater room, hobby room and fitness room, assistant office and storage room. The hot water temperature was measured between 109 and 113 degrees F. which are within the Title 22 regulation. There are no obstruction to the walkway and facility is clean. All the cleaning supplies and chemicals are stored and locked in the storage room. There are four fire extinguishers in the facility and they were last inspected on 5/20/2023. LPA inspected the carbon monoxide detectors and its working well. The day program has a quality care room/quiet room for client to get rest if they are not feeling well. All the clients from the day program would bring lunch and staff would assist them to heat up the food during lunch time. The day program has adequate snacks for clients and there's a water dispenser from the refrigerator in the kitchen for client to use. Currently the facility has 15 clients who are non-ambulatory which is within the fire clearance requirement. The facility continue to practices the infection control and Personal Protective Equipment (PPEs) were observed. The facility still encourages hand washing and checking staff temperature. The facility has an updated Infection Control Plan and COVID-19 mitigation plan in place.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: COLE VOCATIONAL SERVICES COVINA 2
FACILITY NUMBER: 197801934
VISIT DATE: 10/19/2023
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The facility has sufficient staffing in the day program and for the staff-Client ratio and they are maintained the requirement from regional center which is 3:1. LPA inspected four (4) clients files and they have all the required documents in the files which include admission agreement, pre-appraisal assessment, Individual Program Plan (IPP), updated physician report and TB Test result and currently there's no client is under restriction health condition plan. LPA inspected three (3) staff files and they are all over 18 years old, fingerprint cleared and associated with the facility and they have all the required documents which include: health screening, TB test result, updated first aid certificate and required training hours. There's at least one staff has the CPR certificate.
The facility has an updated Emergency Disaster Plan dated on 10/18/23 with relocation sites, shutoff valves, and local emergency contact numbers. The last disaster drill was conducted on 09/29/23.
The facility does not use any restraint on clients at the day program.

No deficiencies were observed during the visit

Exit Interview conducted and the copy of the report was provided to Program Director Miriam Maldonado.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC809 (FAS) - (06/04)
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