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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600769
Report Date: 07/25/2023
Date Signed: 07/26/2023 07:58:14 AM

Document Has Been Signed on 07/26/2023 07:58 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
GREATER LA AC/SC, 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: 41DATE:
07/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Danielle Berger - LicenseeTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Danielle Berger Licensee and explained the reason for the visit.

The day program is licensed to serve 67 ambulatory and 8 non-ambulatory adults. 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.

LPA conducted a tour of the facility with Susan Lujan - Staff and observed the following:
Facility is in good repair inside and outside. The outdoor space provides a shaded basketball court, and shaded sitting area. The main room provides areas for activities. The small rooms are set up for learning activities. There are two restrooms inside and three outdoors in working condition and water temperature tested between 114.6 - 118.7 degrees F., which is within the required 105-120 degrees F. Emergency kit was observed and has the required items. Fire sprinkle system and fire extinguishers were observed throughout the building. Fire extinguishers were last checked on 7/30/23. Kitchen has a refrigerator to store snacks and or food that requires refrigeration. Cleaning supplies and knives are kept inaccessible to the clients in the kitchen. LPA reviewed Safety Compliance Report, Inspection and Testing Form (fire alarm), and Infection Control Plan.

LPA reviewed files for 4 clients and 4 staff. clients#1,#2,#4 (C1,C2,C4) did not have an admission agreement in their file. LIC 610D (10/03) was reviewed.

Deficiencies were noted on LIC 809D per Title 22 Regulations.

Exit interview was conducted with Susan Lujan Staff and a copy of this report, LIC 809D, and appeal rights were provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 07/26/2023 07:58 AM - It Cannot Be Edited


Created By: Mary G Flores On 07/25/2023 at 02:22 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: BEHAVIOR EDUCATION & LEARNING INSTITUTE
FACILITY NUMBER: 198600769

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068(a)
Admission Agreements
(a) The licensee shall complete and maintain an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 clients, C1,C2,C4 did not have an admission agreement on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2023
Plan of Correction
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Director will provide a copy of admission agreement for C1,C2,C4 to the department by POC due date 8/8/23.
Type B
Section Cited
HSC
1565.5
Other Provisions
In addition to any other requirement of this chapter, an adult day program, as defined in Section 1502, shall have an emergency and disaster plan that includes, but is not limited to, all of the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in LIC610D version (10/03) needs to be updated to version (12/21)which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2023
Plan of Correction
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Director will update LIC610D and provide a copy to the department by POC due date 8/8/23.
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:Mary G Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2023


LIC809 (FAS) - (06/04)
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