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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600769
Report Date: 11/05/2021
Date Signed: 11/05/2021 11:55:29 AM

Document Has Been Signed on 11/05/2021 11:55 AM - 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:BEHAVIOR EDUCATION & LEARNING INSTITUTEFACILITY NUMBER:
198600769
ADMINISTRATOR:DANIELLE BERGERFACILITY TYPE:
775
ADDRESS:1919 PALM AVETELEPHONE:
(626) 457-8718
CITY:ALHAMBRASTATE: CAZIP CODE:
91803
CAPACITY: 75CENSUS: 0DATE:
11/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Susan Lujan, Adminstrative AssistanceTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection with the focus of the infection control domain. LPA arrived unannounced and met with Susan Lujan, the Administrative Assistance. The purpose of the visit was explained. The day program is licensed to serve 67 ambulatory and 8 non-ambulatory adults. The program is providing remote services and do not have any clients attending the facility at this time due to the Coronavirus (Covid-19) pandemic.

LPA Chan toured the facility with Mrs. Lujan and observed the following:
* The day program consists of one single story building comprised of 2 offices, the main activity room, a smaller activity room, storage supply rooms, arts & craft room, math room, kitchen, staff break room, and 2 bathrooms. There are 3 additional restrooms in the back area along with a large recreational space. There are several tables outside with shades and a garden area. The facility also has a large room and a log cabin used as storage. Both areas are locked and inaccessible to clients. LPA did not observe any obstructions to the walkways nor any bodies of water.
* Knives and disinfectants are stored and locked in the kitchen under the sink.
* The hot water temperature is measured between 105-120 degree F.
* The fire extinguisher was last inspected on 5/12/21. There are 3 operable carbon monoxide detectors in the building.
* The day program is currently following the COVID-19 recommendations. LPA observed signage posted for hand washing and social distancing, disinfectant stations and masks available throughout the facility, and adequate PPE supplies for at least 30 days.

There are no deficiencies observed during the visit today. Exit interview conducted and a copy of this report and appeal rights were given.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
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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