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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600949
Report Date: 06/07/2022
Date Signed: 06/07/2022 10:47:07 AM

Document Has Been Signed on 06/07/2022 10:47 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:CLIMB, INC. ARF#1FACILITY NUMBER:
198600949
ADMINISTRATOR:NGUYEN, JOHNFACILITY TYPE:
735
ADDRESS:1317 SOUTH GLADYS AVENUETELEPHONE:
(626) 571-2363
CITY:SAN GABRIELSTATE: CAZIP CODE:
91776
CAPACITY: 6CENSUS: 4DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:John Nguyen, AdministratorTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Administrator John Nguyen and explained the purpose of the visit. There are four (4) clients level 4 specialized developmentally disabled clients ages 59 and under. Facility is a two-story home licensed for 6 non- ambulatory clients. It is located in a residential area consisting of five (5) client bedrooms, (1) staff rooms, 3 bathrooms, kitchen, dining room, laundry room, living room, family room, patio area, and attached garage. The facility is equipped with a sprinkler system. The last fire inspection was conducted on 5/26/2022 by San Marino Security Systems Inc. The last emergency disaster drill was completed on 3/10/2022. Administrator certificate expires 10/1/2022.

The following were observed/inspected:
  • COVID-19 Infection Control Practices were observed upon entry and in common areas.
  • Infection control signs, and other signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.
  • Each client bedroom is designated as COVID-19 isolation room if needed.
  • Hand sanitizer was observed in common areas.
  • Staff responsible for direct care and supervision were observed wearing a mask.
  • Clients were not observed wearing masks in the home due to cognitive impairment.
  • Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.
  • A Emergency Disaster Plan was posted. Please update if needed.
  • Sufficient supply of Personal Protective Equipment (PPEs) was observed.
  • Four (4) centrally stored medication records were reviewed.

No deficiencies were cited.
Exit interview was conducted with Administrator John Nguyen. A copy of the report was issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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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