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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601301
Report Date: 11/23/2021
Date Signed: 11/23/2021 12:31:41 PM

Document Has Been Signed on 11/23/2021 12:31 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:AIM HIGHER COVINAFACILITY NUMBER:
198601301
ADMINISTRATOR:GUADALUPE RODRIGUEZFACILITY TYPE:
775
ADDRESS:440 SOUTH CITRUS AVETELEPHONE:
(626) 339-0400
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 80CENSUS: 23DATE:
11/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Amiel Salgado Ramirez, Program DirectorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Tao conducted an unannounced required annual visit and met with Program Director, Amiel Salgado Ramirez, who was explained the reason for the visit. The day program is licensed for eighty (80) Developmentally Disable clients, ages 18 and over and approved for twenty (20) non-ambulatory. Currently, there are 23 clients attending the program today. Annual fee was paid.

During the visit, the infection control domain tool was used, a tour of the facility was conducted and medication was reviewed. Facility does not provide snacks. No meal is served or provided at the day program.

The facility is a single story facility located in a residential neighborhood. The facility consists of a life skill room, vocational room, art room, outing room, conference room, director office, changing room/ isolation room, kitchen/break room, lobby/reception, and two clients/staff restrooms. Water temperature in the bathroom measured at 108.5 degrees Fahrenheit which is within the required range of 105 - 120 degrees. The restrooms were observed to be clean and have the required grab bars. Toilets are operable. The facility is maintained at a comfortable temperature of 73 degrees Fahrenheit. Facility smoke detectors are monitored by Bay Alarm company. Carbon monoxide device is operable. Fire extinguishers’ last service is on 12/11/2020. First aid kit is fully stocked with all required items. The facility is free of odors. Disinfectants and cleaning supplies are stored in locked closets. Rooms are observed to be safe for consumers. The kitchen area was toured. The kitchen has a refrigerator and sink. There was sufficient staff present during the visit and consumers were observed to be involved in activities. Signages and mandated documents are posted.

Per Title 22 Regulations, there were no deficiencies observed during the visit. Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
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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