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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600626
Report Date: 09/12/2022
Date Signed: 09/12/2022 05:18:39 PM

Document Has Been Signed on 09/12/2022 05:18 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:NEW BEGINNINGS ATCHINSONFACILITY NUMBER:
198600626
ADMINISTRATOR:JANICE COLLINSFACILITY TYPE:
735
ADDRESS:403 ATCHISON STREETTELEPHONE:
(626) 398-0911
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 6CENSUS: 3DATE:
09/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:48 PM
MET WITH:Margaret Harvey, AdmnistratorTIME COMPLETED:
05:30 PM
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On 9/12/2022 Licensing Program Analyst (LPA) Bennette Pena conducted a required annual inspection. LPA was greeted by Sanyiza Busby (DSP II) Staff #1 (S1) who arrived at the same time. LPA was also greeted by Mathilde Tallayamande (DSP II), Staff #2 (S2) who opened the door, Paola Arcineda, (Behaviorist), Staff #3 (S3) and LPA explained the reason for the visit. S2 screened and checked LPA's temperature prior to letting me in the home and asked to sign in the visitors sign-in sheet shortly thereafter. LPA spoke with the Administrator, Margaret Harvey on the phone and arrived at 3:52pm in the facility. Currently, the home has (3) ambulatory clients and (0) non-ambulatory client. The facility is serviced by Frank D. Lanterman Regional Center clients with ages of 18-59. LPA used the infection control tool to evaluate the facility. LPA observed the physical plant, COVID-19 procedures, reviewed clients' medications and records, staff records and observed the food supplies.

LPA toured the facility with S2 and S3 and observed/inspected the following:


  • This facility is a 2 story home located in a residential area. There are 4 bedrooms, 2 1/2 bathrooms, living room, dining room, kitchen, laundry space, and a detached garage. There are no obstructions to the passageways or bodies of water at the facility. Upstairs are two (2) client bedrooms, one (1) storage room and one (1) full bathroom. One (1) client bedroom is located downstairs next to the kitchen.
  • All clients rooms contained required furniture including bed, dresser, night stand, lamp and chair. Client bedroom #1 have missing switch plates.
  • Smoke detectors/carbon monoxide detectors and auditory devices in the exit doors were present and operable.



CONTINUED ON LIC 809-C....
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2022
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: NEW BEGINNINGS ATCHINSON
FACILITY NUMBER: 198600626
VISIT DATE: 09/12/2022
NARRATIVE
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  • Covid-19 signage are posted at the facility. Staff screened and took the temperature of LPA upon arrival.
  • Cleaning solutions are stored and locked under the kitchen sink.
  • Knives and sharps are locked in a kitchen cabinet and inaccessible to clients.
  • Medications were locked and centrally stored. Medications were reviewed for all 3 clients and did not observe any discrepancies.
  • Facility has 30 days of PPE supplies.
  • Sufficient food supply of 2-day perishable and 7-day nonperishable were observed.
  • There were 2 fire extinguishers, one was located upstairs and did not have a tag and the other one located downstairs in the kitchen area was last inspected and serviced on 2/15/2021.
  • Hot water temperature was measured within the required range of 105-120 degree Fahrenheit. Bathroom #1 was measured at 108.2 deg F, bathroom #2 was measured at 112.3 deg F and the kitchen sink hot water temperature reading was 113.1 deg F.
  • The backyard has a patio area with tables and chairs for clients use but not shaded. There used to be a patio umbrella but according to S2, it was thrown away because it broke when there was high-wind in the area.
  • There were broken door and hot water tank in the backyard and needed to be cleared.
  • The door or cover securing the hot water tank in the side yard was broken.


Pursuant to Title 22, deficiencies were cited on the attached 809D. An exit interview was conducted and a copy of this report and appeal rights were provided to the Administrator , Margaret Harvey
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 09/12/2022 05:18 PM - It Cannot Be Edited


Created By: Bennette Pena On 09/12/2022 at 04:36 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 BEGINNINGS ATCHINSON
FACILITY NUMBER: 198600626

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(c)
Building and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, the Administrator did not comply with the section cited above in which broken door and hot water tank were in the backyard and the existing hot water tank cover was also broken which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2022
Plan of Correction
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Administrator will clear and clean the backyard area by discarding the broken door and hot water tank. Administrator will also fix the existing hot water tank cover. Photo(s) and receipts will sent to LPA/CCLD on or before POC due date.
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:Christine Yee
LICENSING EVALUATOR NAME:Bennette Pena
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2022


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 09/12/2022 05:18 PM - It Cannot Be Edited


Created By: Bennette Pena On 09/12/2022 at 04:52 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 BEGINNINGS ATCHINSON
FACILITY NUMBER: 198600626

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85087.2(b)
85087.2
Outdoor Activity Space

(b) The outdoor activity area shall provide a shaded area, and shall be comfortable, and furnished for outdoor use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, the licensee did not comply with the section cited above in which the patio area was not shaded and there was no patio umbella which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2022
Plan of Correction
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Administrator will replace the patio umbrella and send photo(s) and receipts or invoice to LPA/CCLD on or before POC due date.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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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:Christine Yee
LICENSING EVALUATOR NAME:Bennette Pena
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2022


LIC809 (FAS) - (06/04)
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