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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601492
Report Date: 11/29/2022
Date Signed: 11/30/2022 03:19:36 PM

Document Has Been Signed on 11/30/2022 03:19 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:BEGINNINGSFACILITY NUMBER:
198601492
ADMINISTRATOR:HOLLAND, TRAVISFACILITY TYPE:
735
ADDRESS:1112 BASELINE RDTELEPHONE:
(909) 305-0250
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY: 3CENSUS: 2DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Yvette RamirezTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Required 1-year visit focusing on COVID-19 Infection Control Practices. LPA met with Administrator Yvette Ramirez and explained the purpose of our visit. The facility is approved for three (3) ambulatory developmentally disabled adults, ages 18-59. There are currently 2 clients residing in this facility and receive case management services provided by San Gabriel Regional Center.

The facility is a single-story residential home located on a main street. The home consists of (3) private client bedrooms, living room, kitchen, dining area, laundry room is located inside the attached 2 car garage.

All client bedrooms were toured. Bedrooms #1 and #2 contained a bed, linen, dresser, chair, light, and sufficient closet space. Bedroom #3 is unoccupied and empty. Both bathrooms contain non-skid mats and were observed to be stocked with soap and hand sanitizer. Due to clients stuffing paper towels in the toilet, staff keeps paper towels stocked in near by hallway closet. LPA tested water in kitchen at 112.2 degrees which is within the required 105- 120 degrees. Cleaning supplies were observed to be locked in the garage which is inaccessible to clients. LPA observed the refrigerator to have the sufficient required 2-day perishable and 7-day nonperishable.

*Continued on 809-C

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEGINNINGS
FACILITY NUMBER: 198601492
VISIT DATE: 11/29/2022
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LPA reviewed 2 client records to confirm emergency contact is updated and residents have health screening on file. 8 staff records were reviewed to confirm health screenings, infection control training, and fingerprint clearances. LPA reviewed 2 clients’ medications records. Medications are documented properly and stored in a locked closet located near the main entry area.

No deficiency were observed. LPA conducted exit interview and a copy of the report will be emailed.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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