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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601301
Report Date: 05/05/2022
Date Signed: 05/18/2022 08:14:54 AM

Document Has Been Signed on 05/18/2022 08:14 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: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: 21DATE:
05/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Amiel Salgado, Program DirectorTIME COMPLETED:
02:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA explained the purpose of the visit to Program Director Amiel Salgado. The Day Program is licensed to serve 80 developmentally disabled adults ages 18 and over, of which 20 may be non-ambulatory. During the today's visit, LPA toured the physical plant. The facility provides transportation services and is equipped with 3 vans.

Physical Plant: Facility is a one story building located in a commercial area. The program consists of a lobby area, exercise area, multipurpose room, arts & expression room, classroom, changing room, kitchen, patio area, Director's office, and conference room. The last disaster drill was conducted on 5/11/2021. The facility's last fire inspection was conducted on 7/29/2021 by LA County Fire Department.
  • In-person day programming resumed in July 2021.
  • COVID-19 Infection Control signs to promote hand washing, cough/sneeze etiquette, and physical distancing were observed in the entrance, common areas, hallways, and bathrooms. LPA was screened upon entry by staff. Facility has an approved COVID-19 mitigation plan.
  • Disinfectant products are available in all activity rooms and tables.
  • Restrooms have sufficient soap and posted hand washing signs.
  • Day program only administers medications for 1 client. Records were reviewed.
  • The Changing room will be used as a COVID-19 isolation room if needed.
  • Personal Protective Equipment (PPE's) of more than 30 days were observed.
  • Staff were observed wearing masks. Staff and client files were not reviewed during today's visit.
  • A posted Emergency Disaster Plan was observed.
  • A technical advisory was issued in reference to regulation 82087.


Deficiency was cited.
Exit interview was conducted with Program Director. A copy of the report and appeal rights were issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2022
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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Document Has Been Signed on 05/18/2022 08:14 AM - It Cannot Be Edited


Created By: Noemi Galarza On 05/05/2022 at 01:36 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: AIM HIGHER COVINA
FACILITY NUMBER: 198601301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82023(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on document review, the licensee did not comply with the section cited above in that the last disaster drill was conducted on 5/11/2021, and the day program resumed programming in July 2021; which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/19/2022
Plan of Correction
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Program Director shall conduct a disaster drill once every 6 months. Submit proof of training by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lisa Hicks
LICENSING EVALUATOR NAME:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022


LIC809 (FAS) - (06/04)
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