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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601894
Report Date: 03/11/2022
Date Signed: 03/11/2022 04:39:19 PM

Document Has Been Signed on 03/11/2022 04:39 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:CLIMB, INC. - ARF 2FACILITY NUMBER:
198601894
ADMINISTRATOR:FILIMON GEBREMICHAEFACILITY TYPE:
735
ADDRESS:2298 W. MAIN STREETTELEPHONE:
(626) 289-5322
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY: 6CENSUS: 6DATE:
03/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Evelyn Brindis, Administrator TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection with the focus of the Infection Control domain. LPA met with the Administrator, Evelyn Brindis, who assisted with the inspection. The purpose of the visit was explained. The facility is licensed to serve 1 non-ambulatory and/or 5 bedridden adults with a capacity of 6.

LPA toured the facility with the Administrator and observed the following:
* The facility has 5 bedrooms, 2 bathrooms with toilet and sink, living room, dining room, kitchen, and 1 larger bathroom that consists of 2 shower stalls, toilet, and laundry area. The clients' rooms have the required furniture. 4 out of the 5 bedrooms have exit doors with alert system. The facility is well maintained with no items obstructing the passageways. LPA observed signage throughout the facility and in the restrooms for hand washing hygiene. LPA recommended to add additional signage such as sneeze/cough etiquette at the home. PPE supplies for at least 30 days are observed. Food supplies for 2 day perishable and a week of non-perishable are also observed. Knives, cleaning solutions, and disinfectants are stored and locked making them inaccessible to clients. Smoke and carbon monoxide combination detectors are located throughout the facility and operable. The fire extinguishers were last inspected on 5/18/2021. The medications are centrally stored and locked. LPA reviewed 5 clients' medications and staff are administering them as prescribed.

LPA provided a technical advisory for the N95 Fit Testing.

No deficiencies were observed during the visit today. An exit interview was conducted and a copy of this report along with appeal rights were given to Staff.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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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