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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601301
Report Date: 05/22/2023
Date Signed: 05/22/2023 04:03:55 PM

Document Has Been Signed on 05/22/2023 04:03 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
GREATER LA AC/SC, 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: 39DATE:
05/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Leticia Hernandez TIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with Program Aide Norma Iniguez allowed the entry of the facility. Shortly after, LPA met with the Assistant Program Director Leticia Hernadez and assisted with the visit. The purpose for the visit was explained. The facility is licensed for EIGHTY (80) DEVELOPMENTALLY DISABLED ADULTS AGES 18 AND ABOVE. TWENTY (20) CLIENTS MAY BE NON-AMBULATORY.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and inspected those domain:

1, Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting daily for the facility. Facility has sufficient PPE supplies and has an Infection Control Plan.

2. Physical Plant and Environmental Safety: The facility is located in a commercial area. The facility consists of reception area, life skills room, program director office, staff break room/conference room, kitchen, art room, changing/quiet room, outing room, vocational room, men and female bathroom and patio area with shaded for client to utilize. The hot water temperature in men and female bathroom and the sink next to the back door entrance were tested between 110.4 and 117.8 degrees F which is within the Title 22 regulation. The carbon monoxide detector is located outside staff break room/conference room and is working probably. The sharp knives and utensils are locked in the kitchen drawer. All the cleaning supplies and chemical are locked in the cabinet around the art room. All outdoor area and passageway are free of obstruction.

3. Operational Requirement: The facility maintained a fire clearance approved by the fire department which they currently have only 6-7 non-ambulatory clients in the day program
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: AIM HIGHER COVINA
FACILITY NUMBER: 198601301
VISIT DATE: 05/22/2023
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4. Staffing: There's sufficient number staffing in the facility. The staff and clients are 1:4 ratio

5. Personnel Records/Training: The staff file is maintained in the facility and locked in the locked cabinet in the staff break room/conference room. The staff has required 8 hours of training each year. All staff are fingerprint clearance and associated with the facility and they are all over 18 years old.

6. Clients Record-Incident Report: All the clients' files are maintained in the facility and its stored and locked in the program director office. All the clients files have required documents which included admission agreement, physician report with TB Test result, Individual Personalized Plan (IPP) and appraisal. Currently there's no client has restricted health condition.

7.Client's Right-Information: Staff understand that each client shall have personal right. Currently there's no client with postural support assistance.

8. Food Service: LPA did not observe any toxic substance in the kitchen area or food preparation area.

9.Health Related Services: Currently there's one client in the facility to be administered the medication at the day program. The mediation is centrally stored and locked in the Program Director Office. LPA inspected the medication and seemed accurate and updated. All staff have updated CPR and First Aid Certificate. The facility is not operating AED at the day program

10. Incidental Medical Services: Its not applied to the facility as currently there's no client is under restricted health condition.

11. Disaster Preparedness: The facility has an updated Emergency Disaster Plan (LIC610D) dated on 12/29/22 and posted near the reception area. The facility fire drill was last conducted on 3/23/23

12. Emergency Intervention: It's not applied in the facility. No restraint or Pro Act are used in the facility.

No deficiencies were observed during the visit

Exit Interview conducted and a copy of the report was emailed to Assistant Program Director Leticia Hernandez.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC809 (FAS) - (06/04)
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