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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601372
Report Date: 11/07/2023
Date Signed: 11/07/2023 01:43:35 PM

Document Has Been Signed on 11/07/2023 01:43 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: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: 38DATE:
11/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Cheryl Jackson - Administrator/SupervisorTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tena Herrera along with Jade Xu, conducted an unannounced visit for an Annual Inspection. Upon arrival, LPA met with Ian Baker (Administrator at sister facility), and Monique Jordan (back up Administrator) and Cheryl Jackson who later assisted with the visit, LPA explained the purpose for the visit. The facility is licensed to serve 60 Adults ages 18 and above.

This is a single- story facility located in Pasadena, Ca. A tour of the facility includes: a bakery with walk-in freezer and walk in oven, 3 storage closets, 4 client restrooms, 1 staff restroom, 2 staff office rooms, isolation room, participant “store”, activity room, craft room and outdoor shaded activity area.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:
Infection Control: The facility staff are using appropriate hand hygiene and cleaning/disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan.
Physical Plant & Environment Safety: Smoke detectors and carbon monoxide detectors are operable and in compliance, there is an emergency sprinkler system throughout the facility. The fire extinguishers were observed and are fully charged. No bodies of water were observed at the facility. The hot water temperature was tested throughout the facility restrooms and measured within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, poisons and hazardous items are stored in a secured/locked storage closet and inaccessible to clients. There is a shaded rest area provided for the clients. Clients are provided with a non-contaminating water container that is readily available for indoor and outdoor use. The facility appears to be clean safe and sanitary. The hand washing station in main activity room was observed to have a leak, details will be provided on the 809D page.
(Continued on 809-C)
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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 11/07/2023 01:43 PM - It Cannot Be Edited


Created By: Tena Herrera On 11/07/2023 at 01:22 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: ONE STEP AHEAD DAY PROGRAM
FACILITY NUMBER: 198601372

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2023

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 as during plant tour LPA observed client hand washing station to have a leaking faucet, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/21/2023
Plan of Correction
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Administrator to repair leak on faucet and provide proof of repair (possible invoice from repair service) via email to LPA 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:David Sicairos
LICENSING EVALUATOR NAME:Tena Herrera
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023


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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ONE STEP AHEAD DAY PROGRAM
FACILITY NUMBER: 198601372
VISIT DATE: 11/07/2023
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Operational Requirements: The facility has the appropriate fire clearance. Staff are knowledgeable on their reporting requirements.
Staffing: There appears to be sufficient staffing at all times in the facility. There are at least 2 staff members on duty any time there are clients in the facility. The staff to client ratio is 1 caregiver to 3 consumers.
Personnel Records-Training: Staff files were readily available during visit. LPA reviewed 5 staff files, each file reviewed have criminal record clearance, current First Aid/CPR and sufficient on-going training. Administrator Cheryl Jackson certificate expired on 11/06/23 and was able to show proof of pending renewal.
Client Records-Incident Reports: Client files are kept in a secure location within the staff office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Consent Forms, and Appraisal Needs & Services Plan. LPA reviewed 5 client records without any issues.
Client Rights-Information: Client Rights Poster is posted within the main office. Per staff interviews conducted, staff were able to provide a number of client rights.
Food Service: Pesticides and other similar toxic substances are not stored in food storerooms or other kitchen areas.
Health Related Services: Staff responsible for providing direct care and supervision maintain training in First Aid and CPR.
Incidental Medical & Dental: Staff have proper training and training is documented within the personnel files.
Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and relocation sites.
Emergency Intervention: Clients at this facility have not needed the use of restraints or the use de-escalation techniques.

LPA conducted 5 staff interviews and 3 client interviews during today’s visit.

Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiency observed during today’s visit is documented on the 809-D.

Exit interview was held and a copy of the report was provided to Cheryl Jackson.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC809 (FAS) - (06/04)
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