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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601372
Report Date: 11/18/2022
Date Signed: 11/18/2022 11:25:54 AM

Document Has Been Signed on 11/18/2022 11:25 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:ONE STEP AHEAD DAY PROGRAMFACILITY NUMBER:
198601372
ADMINISTRATOR:HAMILTON, MARKFACILITY TYPE:
775
ADDRESS:421 DEL MONTE STTELEPHONE:
(626) 794-4103
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY: 60CENSUS: 28DATE:
11/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:Cheryl Jackson - Staff TIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on infection control. LPA Flores met with Cheryl Jackson Staff and explained the reason for the visit. Mark Hamilton Director arrived 30 minutes later.

The facility is licensed as an Adult Day Program for adults between the ages of 18 and over who are developmentally disabled, for a capacity of 60 consumers (10 adults may be Non-Ambulatory). The staff to client ratio is 1 caregiver to 3 consumers. The facility consists of a bakery, isolation room, activity room and a craft room.

LPA Flores and Cheryl Jackson Staff conducted a tour of the facility and observed the following:
Lobby/entrance area has a table set up. No sign in log, or thermometer was observed. Upon review of logs last screening was conducted on 10/14/22. Craft room is set up for 3 people at a time staff was observed wearing a face mask. Activity room was observed set up with a large table, no social distancing was observed between clients, staff were not wearing face masks. Set up area was observed and cleaning supplies were kept inside a metal prep storage unit which does not have a lock, water temperature was tested at 87.4 degrees F. Bathrooms were observed in working condition and water was tested as follow: Bathroom #1(B1) water temperature tested at 89.7 degrees F. and Bathroom #2(B2) tested at 87.8 degrees F. which is not within the required 105-120 degrees F. No hand washing signs were observed or paper towel available. Outdoor area has shaded area and sitting area, to the right of outdoor area a table a hose, basket, turf, two mop buckets, and metal box were observed. Bakery/kitchen area was observed upon entrance a machine on the ground was observed to be in the process of repair which can be a hazard to clients in care. Two staff bathrooms were observed no hand washing signs available. Isolation area is missing storage area with PPE supplies and a trash can for disposing PPE. Kitchen staff were not wearing face mask while preparing food items. Storage area was observed unlock during the visit director attempted to closed lock and was unable to lock, no disinfecting supplies were observed. (CONTINUED ON LIC 809C)
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ONE STEP AHEAD DAY PROGRAM
FACILITY NUMBER: 198601372
VISIT DATE: 11/18/2022
NARRATIVE
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PPE supplies for over 30 days were observed storage in bakery area. No signs were observed throughout the facility for symptoms, cough and sneeze etiquette, social distancing, and mask wearing.

Facility has a fire sprinkle system throughout. Fire extinguishers were observed. Last fire drill conducted on 8/12/22. LPA reviewed 3 client files and 2 staff files. No medication was review as facility does not handle clients' medications.

Deficiencies were noted under Title 22 Regulations and noted on LIC 809D.

Exit interview was conducted with Mark Hamilton Director and a copy of this report, LIC 809D, and technical advisories were provided.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/18/2022 11:25 AM - It Cannot Be Edited


Created By: Mary G Flores On 11/18/2022 at 10:52 AM
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: ONE STEP AHEAD DAY PROGRAM
FACILITY NUMBER: 198601372

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in machine in cleaning supplies are kept in prep unit not locked in preparation area and storage unit was not locked at the time of the visit which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/26/2022
Plan of Correction
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Licensee is to ensure all cleaning, disinfecting, and chemical are maintain lock at all times. Pictures of items removed from prep unit and storage unit new lock to be submitted to the department by POC due date of 11/26/22.
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:Stefanie Coronel
LICENSING EVALUATOR NAME:Mary G Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022


LIC809 (FAS) - (06/04)
Page: 3 of 22
Document Has Been Signed on 11/18/2022 11:25 AM - It Cannot Be Edited


Created By: Mary G Flores On 11/18/2022 at 10:52 AM
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: ONE STEP AHEAD DAY PROGRAM
FACILITY NUMBER: 198601372

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in machine in bakery area place in the floor with tools and debris which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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Licensee is to ensure all areas, and equipment are in working, safe conditions at all times and will remove the machine, tools, and debris making it unaccessible to clients in care. Pictures of area clean to be submitted to the department by POC due date of 11/25/22.
Type B
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(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
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Based on observation, the licensee did not comply with the section cited above in water temperature was tested in B1 at 89.7 degrees F., and B2 was tested at 87.8 degrees F., which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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Licensee is to maintain water temperature within the required 105-120 degrees F., at all times. Licensee will correct water temperature, maintain a log for the next 7 days and submit the log to the department by POC due date of 11/25/22.
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:Stefanie Coronel
LICENSING EVALUATOR NAME:Mary G Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022


LIC809 (FAS) - (06/04)
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