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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600550
Report Date: 08/09/2024
Date Signed: 08/09/2024 02:18:23 PM

Document Has Been Signed on 08/09/2024 02:18 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:NEW DAY BEHAVIORFACILITY NUMBER:
198600550
ADMINISTRATOR/
DIRECTOR:		SANTOS DOMINGUEZFACILITY TYPE:
775
ADDRESS:1755 S. BARRANCA AVE.TELEPHONE:
(626) 966-1136
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY: 30CENSUS: 15DATE:
08/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:18 AM
MET WITH:Administrator Santos DominguezTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced visit at the facility to conduct the required annual inspection. LPA Ramirez was greeted by Administrator Santos Dominguez and explained the purpose for the visit. The facility is an Adult Day Program for Intellectually Disabled Adults, licensed to serve 20 ambulatory and 10 non-ambulatory consumers, ages 18 and over.

This program operates Monday through Friday from 8:00 AM to 2:00 PM and provides services for the developmentally disabled clients. This program has the following: (6) Vocational rooms for skill learning assignments, (1) kitchen, (2) restrooms and (5) staff offices. Storage lockers for both staff and clients observed.

The following were observed/inspected:


Physical Plant: Outdoor and indoor passageways are free of obstruction. Bathrooms were clean and operational, water temperature in compliance. Restroom located in Administration section which is accessible to staff and clients, was observed to contain 2 bottles of disinfectant spray on sink counter. Administrator Dominguez witnessed disinfectant sprays and immediately removed them. LPA Ramirez will issue Type A deficeny based on this observation. Smoke/carbon monoxide detectors were tested and operational. Fire extinguisher observed. Required postings observed. Central Air and Heating with temperature comfortable. Emergency supplies observed. Sharps were observed to be locked and inaccessible to clients. MEDICATION: Not all clients at this program receive medications while in day program. No centrally stored medications were observed. PERSONNEL RECORDS: Four (4) Staff records were reviewed. LPA Ramirez observed First Aid/CPR Certificate, Fingerprint Clearance/ Exemptions, Personnel Record/Job Application, Health Screening, Employee Rights, TB Test, and annual training. CLIENT RECORDS: Client records are maintained at the facility. Admissions Agreement, Medical Assessment, Consent Forms, Appraisal and Needs and Services plan, I.D and Emergency Information, TB Test, and Personal Rights Form were observed in records. Staff on site meet ratio set by regional center. ACTIVITIES: LPA observed activities for client use as well as sufficient space and accommodations for clients to do activities. Three (3) vehicle registrations and insurance were reviewed.

One (1) deficiency was cited during this annual inspection. Exit interview was conducted and a copy of this report, 809-D and appeals rights was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2024
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 08/09/2024 02:18 PM - It Cannot Be Edited


Created By: Kimberly Ramirez On 08/09/2024 at 01:11 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: NEW DAY BEHAVIOR
FACILITY NUMBER: 198600550

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
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. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, restroom located in Administration section which is accessible to staff and clients, was observed to contain 2 bottles of disinfectant spray on sink counter. the licensee did not comply with the section cited above in 15 out of 15 clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2024
Plan of Correction
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Administrator Dominguez removed immediately. No further action required.
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:Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2024


LIC809 (FAS) - (06/04)
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