198601894-2-24-2024-28-AS-KRAZ-D2S6W7-20240224200951

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601894
Report Date: 02/24/2024
Date Signed: 02/24/2024 08:10:35 PM

Document Has Been Signed on 02/24/2024 08:10 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:	CLIMB, INC. - ARF 2		FACILITY NUMBER:	198601894
ADMINISTRATOR:	FILIMON GEBREMICHAE		FACILITY TYPE:	735
ADDRESS:	2298 W. MAIN STREET		TELEPHONE:	(626) 289-5322
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY: 6		CENSUS: 5	DATE:	02/24/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:13 AM
MET WITH:			TIME COMPLETED:	02:15 PM

NARRATIVE

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 02/24/2024. LPA Ramirez was met by Administrator Estrella Del Mundo and explained the purpose of the visit. The facility is approved for six (6) developmentally disabled adults, ages 18-59, of which one (1) may be ambulatory and five (5) bedridden. All clients receive case management services provided by East Los Angeles Regional Center (ELARC).

LPA OBSERVATIONS: The facility is a single-story dwelling located on a main street. The facility consists of five (5) client bedrooms, two (2) bathrooms, one (1) shower room with toilet, kitchen, dining room, living room, front yard, backyard and laundry room.

Front Yard: LPA Ramirez observed front yard to be free of hazards. LPA observed a gate that encloses the front yard from the main street.

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 112.6-degree F. LPA Ramirez observed facility menu on refrigerator. LPA Ramirez observed American Red Cross CPR and First Aid instructions posted on near by wall. LPA Ramirez observed signs near pantry that indicated clients food allergies. Emergency food and water supply are kept in pantry.

Dining Room/Living room: Dining room was observed to contain one table with six (6) chairs. Living room was observed to contain plenty of lighting. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed nearby thermostat to read 72 degrees F. LPA Ramirez observed one (1) client sitting in this area during inspection.

SEE 809-C

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2024

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: CLIMB, INC. - ARF 2	FACILITY NUMBER: 198601894
	VISIT DATE: 02/24/2024

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

Client Rooms 1 - 5: LPA Ramirez observed all client bedrooms to contain the required linens, furnishings, and lighting. LPA Ramirez observed auditory devices in four (4) out five (5) clients bedroom exit doors, to be in “OFF” position during inspection. LPA Ramirez will issue deficiency.

Bathroom 1-2/Bathing room: LPA Ramirez observed non slip mats in bathroom showers. LPA Ramirez observed signage promoting proper handwashing etiquette near sink. Water temperature in bathroom#1 was measured at 119.9 degree F. Bathroom#2 water temperature was measured at 118.9 degree F.

Backyard: No large bodies of water were observed.

Emergency Drills: Last documented disaster drill was conducted on 10/07/2023 and 01/08/2024.

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. LPA Ramirez observed

Personnel Records: Personnel records are maintained at the facility. LPA Ramirez reviewed three (3) personnel records. No deficiency observed. LPA Ramirez observed an Administrator Certificate for Estrella Del Mundo with a expiration date of 06/09/2025.

Client Records: Client files are maintained at facility. LPA Ramirez reviewed five (5) resident records. No deficiency was observed.

Infection Control Plan: LPA Ramirez was unable to access infection control plan. LPA Ramirez will issue Technical Advisory. Administrator will email Infection Control Plan to LPA Ramirez within 7 days.

One (1) deficiency and one (1) technical advisory was cited today. 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: 02/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/24/2024 08:10 PM - It Cannot Be Edited

Created By: Kimberly Ramirez On 02/24/2024 at 01:16 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: CLIMB, INC. - ARF 2	FACILITY NUMBER: 198601894
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80077.3(a)

Care for Clients who Lack Hazard Awareness or Impluse Control

(a) If a client requires protective supervision because of running/wandering away, supervision may be enhanced by fencing yards, using self-closing latches and gates, and installing operational bells, buzzers, or other auditory devices on exterior doors to alert staff when the door is opened. The fencing and devices must not substitute for appropriate staffing. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 5 out of 5 clients, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/08/2024
	Plan of Correction
1 2 3 4	Administrator placed auditory devices to "ON" position during inspection. Licensee will retrain staff on above regulation and send proof of staff re-training by 3/8/24.

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: 02/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2024

LIC809 (FAS) - (06/04)

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