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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600626
Report Date: 09/10/2024
Date Signed: 09/10/2024 04:19:27 PM

Document Has Been Signed on 09/10/2024 04:19 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 BEGINNINGS ATCHINSONFACILITY NUMBER:
198600626
ADMINISTRATOR/
DIRECTOR:		JANICE COLLINSFACILITY TYPE:
735
ADDRESS:403 ATCHISON STREETTELEPHONE:
(626) 398-0911
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 6CENSUS: 4DATE:
09/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:23 PM
MET WITH:Passion Letuli - Back-up AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:24 PM
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. LPA was met by Passion Letuli, Back-up Administrator and explained the purpose of the visit. The facility is licensed to care for (6) Developmentally Disabled Adults, ages 18-59, of which (2) clients may be non ambulatory. Facility is level 4I Specialized. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:
Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Bathrooms have hand washing signs, soap and paper towels. Staff are adhering to infection control requirements.
Physical Plant/Environment Safety: The facility is a 2-story home located in a residential neighborhood, contains a total of (4) client bedrooms, (2) full bathrooms, a living room, office, kitchen, dining area, backyard, and a detached garage. The (4) clients living in the facility receive case management services provided by Frank D. Lanterman Regional Center. The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficient closet space. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap and toilet paper. Exit doors are free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and there were no debris or any obstructions. Kitchen knives, sharps objects, cleaning supplies and toxic substances are locked and inaccessible to clients. There are (2) fire extinguishers, one in each floor, which were last serviced on 09/10/2024. Laundry area is in the detached garage as well as additional refrigerator and freezer. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. The facility has a video camera monitor system in all common areas. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit, bathroom #1 read at 110.2 deg F and bathroom #2 read at 108.1 deg F.
Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been submitted to CCL. A fire clearance is in place. Liability Insurance policy in the amount of $1,000,000.00 each occurrence and $3,000,000.00 in the total annual aggregate is valid and will expire on 08/05/2025. Surety Bond is valid with bond amount of $2000. Last fire drill was conducted on 09/07/2024 and earthquake drill was conducted on 08/13/2024. Both emergency drills are conducted on a monthly basis.
*****REPORT CONTINUED ON LIC809-C****
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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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: NEW BEGINNINGS ATCHINSON
FACILITY NUMBER: 198600626
VISIT DATE: 09/10/2024
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Staffing: A total of sixteen (16) staff members including the Administrator will provide care and supervision to the clients. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility.
Personnel Records/Staff Training: Reviewed files for three (3) staff. Proof of staff training, health clearance, vaccinations and 1st Aid/CPR training are current. Current Administrator certificate is valid and expiring on 04/11/2025.
Client Rights-Information: Client personal rights are posted. Per Administrator, facility has internet service accessible to all clients. Working facility phone is available and accessible to clients.
Client Records-Incident Reports: LPA reviewed (4) client files which are maintained at the facility. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, Individual Program Plan (IPP), Behavioral Reports, Client Cash Resources, Special Incident Reports, Client Personal Property and Clients Personal Rights observed.
Food Service: There are sufficient food supplies of 2-day perishable and 7-day non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly.
Health Related Services: The medications are centrally stored and in their original containers. Medications were reviewed for (4) clients to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician. First aid supplies are maintained and readily available in the facility.
Incidental Medical Services: Per the Interim Administrator, no client at this home with a restricted health condition.
Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan.
Emergency Intervention: Not-Applicable.

No deficiencies cited. Exit interview conducted and a copy of this report was provided to Passion Letuli, Back-up Administrator.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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