197802699-8-25-2022-28-AS-MGFS-CHMPBB-20220825111003

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197802699
Report Date: 08/25/2022
Date Signed: 08/25/2022 11:10:55 AM

Document Has Been Signed on 08/25/2022 11:10 AM - 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:	IRL-THE ALMANSOR CENTER		FACILITY NUMBER:	197802699
ADMINISTRATOR:	NITA DAVIS		FACILITY TYPE:	775
ADDRESS:	211 PASADENA AVENUE		TELEPHONE:	(323) 341-5580
CITY:	SOUTH PASADENA	STATE: CA	ZIP CODE:	91030
CAPACITY: 60		CENSUS: 29	DATE:	08/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:54 AM
MET WITH:	Georgina Hernandez - Program Supervisor		TIME COMPLETED:	11:25 AM

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(s)(LPA) Mary Flores conducted an unannounced annual inspection visit at the facility with focus on infection control domain. LPA met with Georgina Hernandez Program Supervisor and explained the reason of the visit. Adult Day Program operates Monday through Friday from 8:00 AM to 2:00 PM and provides services for the developmentally disabled clients from various Regional Center. This program is a large building consisted of two floors. Facility has two kitchens, one is located upstairs and the other one is located downstairs. Facility has a fire sprinkle system and smoke detectors. LPA toured the facility with Program Supervisor Georgina Hernandez and observed the following: 1st floor has a reception office, 4 staff offices, a staff break area, a vocational area, a kitchen, a large space separated into two homerooms/classrooms #1, and #2, and 2 client/staff restrooms. The basement has one medium space use as homeroom #3, a large space use as homeroom #4,#5,#6, an office space as room #7, and a computer lab area with 6 stations, and 2 client private restrooms. Water temperature was tested in basement client restroom #1(B1) and #2(B2); B1 at 109.0 degrees F., B2 tested at 109.8 degrees F, and kitchen's sink tested at 110.3 Upstairs restrooms #3(B3) and #4(B4) were observed and water temperature was tested as follow; B3 tested at 101.0 and B4 tested at 102.6 which is not within the required 105 -120 degrees F. During the tour LPA noticed sewer smell by B1 and B3, upon observing disinfecting preparation station room Program Supervisor explained the smell is coming from the sewer located in that room. LPA noted the smell and observed a hole of about 2 feet with murky brown water in disinfecting station room. Knives for food preparation/class are kept in a lock drawer in the reception office. Medication or meals are not handle in the facility. Clients bring their meals from home and are stored in the refrigerators available in each kitchen. Files were reviewed for staff #1, #2, and #3, and client #1, #2, and #3. Fire extinguisher was observed in the kitchen area, last checked on 3/1/22 . (CONTINUED ON LIC809D)

SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: IRL-THE ALMANSOR CENTER	FACILITY NUMBER: 197802699
	VISIT DATE: 08/25/2022

NARRATIVE

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Facility is following COVID 19 recommendations, signs are posted throughout the facility, one entry point with electronic screening station for clients, staff, and visitors. High touch areas, and computers are disinfected between uses. Facility is currently keeping a 1:3 ratio within each classroom.

Deficiencies were noted on LIC809D and a technical advisory was provided under Title 22 Regulations.

Exit interview was conducted with Georgina Hernandez Program Supervisor and a copy of the report was provided

SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/25/2022 11:10 AM - It Cannot Be Edited

Created By: Mary G Flores On 08/25/2022 at 10:47 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: IRL-THE ALMANSOR CENTER	FACILITY NUMBER: 197802699
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82087(a)

Buildings and Grounds

(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in during the tour LPA noted sewer smell by B1, B3, and disinfecting station room as well as a 2 feet hole with murky brown water which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/08/2022
	Plan of Correction
1 2 3 4	Licensee will contact proper cleaning agency/plumbing to ensure the sewer in the basement in the disinfecting preparation room gets clean and will send a copy of invoice of service provided as well as a picture of the area by POC due date of 9/8/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Stefanie Coronel

LICENSING EVALUATOR NAME:

Mary G Flores

LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022

LIC809 (FAS) - (06/04)

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