198601301-5-22-2025-28-AS-DKOI-DGWVFD-20250522162346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601301
Report Date: 05/22/2025
Date Signed: 05/22/2025 04:24:01 PM

Document Has Been Signed on 05/22/2025 04:24 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	AIM HIGHER COVINA		FACILITY NUMBER:	198601301
ADMINISTRATOR/ DIRECTOR:	GUADALUPE RODRIGUEZ		FACILITY TYPE:	775
ADDRESS:	440 SOUTH CITRUS AVE		TELEPHONE:	(626) 339-0400
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY: 80		CENSUS: 50	DATE:	05/22/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:35 PM
MET WITH:	Amiel Salgado, Program Director		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

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Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced annual inspection at the facility. LPA met with Amiel Salgado (Program Director) and explained the purpose of the visit. The facility is licensed to serve 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 which contain the following nine (9) domains: Infection Control, Physical Plant & Environment Safety, Operational Requirements, Staffing, Client Records-Incident Report, Food Services, Incidental Medical Services, Disaster Preparedness, and Emergency Intervention.

Infection Control: Facility has an updated infection control plan in place, Facility continues to practice the infection control in the facility. Facility also has sufficient PPE supplies in the facility.

Physical Plant and Environmental Safety: The day program included: Lobby, conference room, life skills room, Staff break room, art room, vocational room, outing room, quiet room/changing room and administrator office and one men and one women restrooms. LPA inspected the restrooms and they are sanitary, clean and in a good working condition. The hot water temperature in both restrooms were tested between 103.1- and 116.0 degrees F which is not within the Title 22 regulation. All chemicals and cleaning supplies are stored and locked in a cabinet near the art room. All the sharp knives are stored and locked under the sink in the staff break room. LPA inspected the carbon monoxide detector and it's working well. The passageway and walkway are free of obstruction. There are two (2) fire extinguisher with one (1) in the life skills room and one (1) in the front lobby. Both fire extinguishers are fully charged and last inspected on 11/06/2024.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: AIM HIGHER COVINA	FACILITY NUMBER: 198601301
	VISIT DATE: 05/22/2025

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Operational Requirements: The facility is licensed for 80 developmentally disabled adults aged 18 and above and 20 may be non-ambulatory. Currently there are only five (5) clients in the facility are non-ambulatory which is within the fire clearance requirement.

Staffing: There's sufficient staffing in the facility. The regional center required 4: 1 ration for clients to staff. The facility always has at least two staff on duty at all times.

Client's Right Information: Currently the facility has no client required postural support. The client's right is always reviewed during the meeting annually.

Food Service: The clients usually bring their lunch and snacks to the facility daily and staff would assist clients to heat up the food from the microwave and the facility has a water dispenser which is available for client to use. All toxins and cleaning supplies are secure, locked, and placed in the janitorial closet away from food supplies.

Incidental Medical Services: Currently the facility has no client with any restricted health condition. There's one client who has diabetes but client is capable to perform her own glucose testing.

Disaster Preparedness: The facility has an updated emergency disaster plan and dated on 11/30/23. The last disaster drill was conducted on 04/04/2025.

Emergency Intervention: The facility does not use any restraint on clients.

Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies observed during the visit are documented on the LIC809-D. Exit Interview conducted and a copy of the report and appeal rights were provided to the Program Director, Amiel Salgado.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/22/2025 04:24 PM - It Cannot Be Edited

Created By: Daniel Konishi On 05/22/2025 at 04:10 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: 05/22/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82088(e)(1)

(e) Faucets used by clients for personal care shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, LPA measured water temperature in the men's bathroom at 103.1 Degrees F which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/29/2025
	Plan of Correction
1 2 3 4	Licensee shall immediately adjust water temperature. Licensee to check water temperature at various different times throughout the day and maintain and submit a water temperature log to the LPA for the next 3 days to ensure that hot water temperature falls within 105 degree F and 120 degrees F. Licensee will provide a copy of the log to the department once water temperature falls within Title 22 guidelines

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	David Sicairos
NAME OF LICENSING PROGRAM MANAGER:

	Daniel Konishi
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/22/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC809 (FAS) - (06/04)

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