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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802699
Report Date: 08/15/2023
Date Signed: 08/15/2023 12:21:05 PM

Document Has Been Signed on 08/15/2023 12:21 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:IRL-THE ALMANSOR CENTERFACILITY NUMBER:
197802699
ADMINISTRATOR:KARISSA TRESSAFACILITY TYPE:
775
ADDRESS:211 PASADENA AVENUETELEPHONE:
(323) 341-5580
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY: 60CENSUS: 58DATE:
08/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Karissa Tressa - AdministratorTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual inspection visit at the facility using the CARE tool. LPA met with Karissa Tressa Administrator and explained the reason of the visit.

Adult Day Program operates Monday through Friday from 8:00 AM to 2:00 PM and is licensed to served 60 developmentally disabled ambulatory adults. This program is a large building consisted of two floors. Facility has 5 staff offices, two job development/computer areas, 2 large rooms and 2 smaller rooms, two kitchens, and 4 restrooms.

LPA and administrator toured the facility and observed the following:
Facility has a fire sprinkle system and smoke detectors throughout the building. Outdoor and indoor spaces are in good repair. Both kitchens are free of hazardous. Sharps are kept lock in the office. Rooms are clean and provide group seating space for clients and staff. All restrooms were observed in working condition and clean. Water temperature was tested in each restroom's sink and tested between 110.1-116.7 degrees F., which is within the required 105-120 degrees F. First Aid kits were observed in each floor and Blood bourne pathogen/bodily fluid kits were observed throughout. Fire Extinguishers were observed and last checked on 4/28/23. Outdoor garden was observed with shaded seating area and passage is clear of obstructions.

LPA reviewed 6 client files and 5 staff files. 5 out of 6 clients (C2-C6) had an Individual Plan (IPP) older than 1 year.C2 IPP date: 9/3/2020, C3 Next IPP 7/31/23, C4 Trinnial IPP date review: 6/27/2017, C5 Next IPP Date: 9/30/22, C6 Next IPP: 1/31/2022. Emergency Disaster Plan was reviewed last checked on 4/27/23. Last Fire Drill was conducted on 7/10/23. Interviews were conducted with 4 clients and 4 staff.

Deficiency noted on LIC 809D per Title 22 Regulations.
Exit interview was conducted with Karissa Tressa and a copy of this report, LIC 809D, and appeal rights were provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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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Document Has Been Signed on 08/15/2023 12:21 PM - It Cannot Be Edited


Created By: Mary G Flores On 08/15/2023 at 11:34 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: 08/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068.2(d)(1)
Needs and Services Plan
(d) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: (1) The needs appraisal or IPP is not more than one year old.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 5 out 6 client, C2-C6 IPP were not current which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/29/2023
Plan of Correction
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Administrator will submit a copy of current IPP to the department by POC due date 8/29/23.
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:Tony Vasallo
LICENSING EVALUATOR NAME:Mary G Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2023


LIC809 (FAS) - (06/04)
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