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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802699
Report Date: 07/11/2024
Date Signed: 07/11/2024 12:53:03 PM

Document Has Been Signed on 07/11/2024 12:53 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/
DIRECTOR:		KARISSA TRESSAFACILITY TYPE:
775
ADDRESS:211 PASADENA AVENUETELEPHONE:
(323) 341-5580
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY: 60CENSUS: 53DATE:
07/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Georgina Hernandez - Program SupervisorTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual inspection visit at the facility using the CARE inspection tool. LPA met with Georgina Hernandez and explained the reason of the visit.

Facility is licensed to serve 60 developmentally disabled ambulatory adults as an Adult Day Program, which operates Monday through Friday from 8:00 AM to 2:00 PM. This program is a large commercial building and consists of two floors with a lobby, 5 staff offices, two job development/computer areas, 2 large activity rooms and 2 smaller activity rooms, two kitchens, an elevator, and 4 restrooms.

LPA toured the facility with Karissa Tressa Program Director and observed the following:
Facility is in good repair inside and outside. Each activity area was observed clean with sufficient work and sitting furniture and within a ratio of 1 staff per 3 participants. All other areas were observed clean and free of debris, sharps, or hazardous. Elevator is in good repair. Kitchen areas are clean, cabinets are used to stored items for cooking activities. Refrigerators were observed clean and in good repair. Bathrooms were observed clean and in good repair. Water temperature was tested in each bathrooms' sinks and kitchens' sinks and tested between 110.2 degrees F. - 116.6 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 3/27/24. Outdoor area was observed with shading area and exit passage way was observed with a garden bed and large trash can against the wall, which will be cleared per program director by the end of the week. Smoke/Carbon monoxide detectors were observed throughout. Facility has a fire sprinkler system throughout as well.

LPA reviewed files for 5 participants and 5 staff. Participant #1(P1) takes medication for health condition which was being stored in P1's possession in a lunch bag and no prescription/label was kept for instructions of storage and dosage. A plan was observed for P1's health condition on file. (CONTINUED ON LIC 809C)
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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 5
Document Has Been Signed on 07/11/2024 12:53 PM - It Cannot Be Edited


Created By: Mary G Flores On 07/11/2024 at 12:13 PM
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: 07/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82075(l)(1)
Health-Related Services
(l) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interviews, the licensee did not comply with the section cited above in P1's injectable medication was being stored in P1's lunch bag in P1's possesion which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2024
Plan of Correction
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Program Director will obtain a lock box for the refrigerator and store the medication in the refrigerator in the office and will submit a picture of the lock box to the department by POC due date 7/12/24.
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: 07/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 07/11/2024 12:53 PM - It Cannot Be Edited


Created By: Mary G Flores On 07/11/2024 at 12:13 PM
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: 07/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82075(l)(3)
Health-Related Services
(l) The following requirements shall apply to medications which are centrally stored: (3) All medications shall be labeled and maintained in compliance with label instructions and state and federal laws.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in P1's medication was observed but the physician's prescription, and/or label for the medication was missing which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
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Program Director will obtain a copy of the prescription/label of medication to maintain on file and medication and submit a copy to the department by POC due date 7/15/24.
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: 07/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
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: IRL-THE ALMANSOR CENTER
FACILITY NUMBER: 197802699
VISIT DATE: 07/11/2024
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Program Director has completed 30 hours of continuous education within 24 months and staff have completed more than 8 hours of continuous education. LPA reviewed Emergency Disaster plan and Infection Control plan. Last emergency drill was conducted on 5/20/24.

Deficiencies were 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: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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