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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600769
Report Date: 08/18/2022
Date Signed: 08/18/2022 05:37:19 PM

Document Has Been Signed on 08/18/2022 05:37 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: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:
08/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Susanne Lujan, TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted an annual inspection with the focus of the infection control domain. LPA arrived unannounced and met with Susan Lujan, the Administrative Assistance. The day program is licensed to serve 67 ambulatory and 8 non-ambulatory adults. There are currently no clients attending the day program in person as services are provided remotely.

LPA Chan toured the facility with Mrs. Lujan and observed the following:
* The day program consists of one single story building comprised of multiple small rooms used as office space or to conduct activities. There is a large activity room in the center of the building and a kitchen. The tables and chairs in the activity rooms are socially distanced.
* The log cabin located to the left of the building is used as storage only.
* There were no obstructions to the walkways.
* There are hand sanitizers and masks available at each working station. LPA observed more than 30 days of PPE supplies stored onsite.
* Knives and disinfectants are stored and locked in the kitchen under the sink.
* The bathrooms are stocked with hand soap and paper towels.
* Emergency contact numbers have been updated.
* The fire extinguishers were last inspected on 5/6/22. There are 3 operable carbon monoxide detectors in the building.
* The day program is continuing to follow the COVID-19 recommendations.

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: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2022
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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