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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601730
Report Date: 09/14/2022
Date Signed: 09/14/2022 02:17:04 PM

Document Has Been Signed on 09/14/2022 02:17 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CAPS ALZHEIMER'S DAY SERVICESFACILITY NUMBER:
198601730
ADMINISTRATOR:VATCHE KELARTINIANFACILITY TYPE:
775
ADDRESS:2501 E CORTEZ ST,N WING #14-16TELEPHONE:
(626) 917-4484
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY: 30CENSUS: 1DATE:
09/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:11 PM
MET WITH:Elizabeth Morgan NadeaTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced Annual Inspection at the facility. Upon arrival, LPA met with Program Room Aide Melody Flores and explained the purpose of the visit. At 1:15pm, the program director Elizabeth Morgan Nadea arrived and assisted with the visit.

Facility is licensed to served ambulatory adults age 18 and older. Facility serves an adult day program capacity. Facility is a one (1) building with an outside activity area that includes the patio, program room, kitchen area, program director office and there are two (2) bathrooms (one for men and one for women) with fully functioning appliances outside the CAP program which shared with West Covina Senior Center.

LPA conducted a tour of the facility with the program director and observed the following:
Restrooms water temperature were tested between 110 and 118 degrees F which is within the 105 - 120 degrees F. Facility has one fire extinguisher was observed throughout the facility. Facility has a first aid kit and its stored in a locked cabinet which contains the required items. All the sharp knives and utensils and cleaning supplies are kept under lock in the cabinet. Clients in care for less than 8 hours is provided meals and snacks and LPA observed the facility has sufficient food supply.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, social distancing by allowing a number of people in each room, facility is disinfected multiple times a day. and the restrooms have sufficient soap, paper towels, and signs, facility has an isolation room and PPE supplies are sufficient for more than 30 days.

No deficiencies were observed during today's visit.

An exit interview was conducted and a copy of this report was provided to Program Director Elizabeth Morgan Nadea
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2022
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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