198601492-12-21-2023-28-AS-KRAZ-CYQUHH-20231221143558

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601492
Report Date: 12/21/2023
Date Signed: 12/21/2023 02:36:10 PM

Document Has Been Signed on 12/21/2023 02:36 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:	BEGINNINGS		FACILITY NUMBER:	198601492
ADMINISTRATOR:	HOLLAND, TRAVIS		FACILITY TYPE:	735
ADDRESS:	1112 BASELINE RD		TELEPHONE:	(909) 305-0250
CITY:	LA VERNE	STATE: CA	ZIP CODE:	91750
CAPACITY: 3		CENSUS: 2	DATE:	12/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Co Administrator Yvette Ramirez		TIME COMPLETED:	02:30 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 12/21/2023. LPA Ramirez was met by Co-Administrator Yvette Ramirez and explained the purpose of the 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/Pomona Regional Center.

LPA OBSERVATIONS: The facility is a single-story dwelling located on a main street. The facility consists of three (3) client bedrooms, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard and attached garage.

Front Yard: LPA Ramirez observed front yard to be free of hazards. Front yard was well maintained.

Kitchen: LPA Ramirez observed appliances to be in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed a fully charger fire extinguisher nearby. Kitchen sink temperature was measured at 112.8-degree F. LPA Ramirez observed facility menu on refrigerator.

Dining Room/Living room: Dining room was observed to contain one table with four (4) chairs. Living room was observed to contain plenty of lighting. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed signage promoting cough and handwashing etiquette in this area. LPA Ramirez observed nearby thermostat to read 72 degrees F.

Linen Closet/Supply Closet: Observed to contain plenty linens, towels, and hygiene products.

See 809-C

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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 6

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: 12/21/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Client Rooms 1 - 3: LPA Ramirez observed client bedrooms#1-3 to contain the required linens, furnishings, and lighting. Client bedroom#1 is currently unoccupied. Client bedroom#1 door was observed with a vertical crack near the middle of the outside of door. LPA Ramirez will issue deficiency. Client bedroom#2 has a private bathroom. LPA Ramirez observed window blinds in this bathroom to be in disrepair. LPA Ramirez will issue deficiency.

Bathroom 1-2: LPA Ramirez observed non slip mats in bathrooms showers. LPA Ramirez observed signage promoting proper handwashing etiquette near sink. Water temperature in bathroom#1 was measured at 112.9 degree F. Bathroom#2 located in client bedroom#2, water temperature was measured at 112.8 degree F. Trash bins were observed to not have tight fitting lids. LPA Ramirez will issue Technical Violation.

Backyard: No large bodies of water were observed. Discarded gray recliner was observed near pathway. LPA Ramirez will issue Technical Violation.

Emergency Drills: Last documented disaster drill was conducted on 12/2/23 at 3:34pm.

Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide and smoke detectors in hallways. Smoke detectors were observed to be operable during visit.

Personnel Records: Personnel records were not maintained at the facility. Personnel records were brought within 10 minutes. LPA Ramirez reviewed five (5) personnel records. Four (4) out of the five (5) personnel records reviewed did not have updated first aid training after 12/2/2023.

Client Files: Client files were maintained at facility. LPA Ramirez reviewed two (2) resident records.

Infection Control Plan: LPA Ramirez reviewed current infection control plan.

Exit interview was conducted. A copy of this report, 809-D, LIC 9102, and appeals rights was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

Page: 2 of 6

Document Has Been Signed on 12/21/2023 02:36 PM - It Cannot Be Edited

Created By: Kimberly Ramirez On 12/21/2023 at 01:13 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: BEGINNINGS	FACILITY NUMBER: 198601492
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)

Building and Grounds

(a) The facility 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
1 2 3 4	Based on observation, client bedroom#1 door was in disrepair and client bathroom#2 window blinds were in disrepair, the licensee did not comply with the section cited above in 2 out of 2 clients which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/04/2024
	Plan of Correction
1 2 3 4	Licensee will replace door and repair or replace blinds. Send picture proof by 1/4/2024 via email.

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.

SUPERVISOR'S NAME:

Tony Vasallo

LICENSING EVALUATOR NAME:

Kimberly Ramirez

LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

Page: 3 of 6