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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602059
Report Date: 06/30/2021
Date Signed: 04/21/2022 03:53:45 PM

Document Has Been Signed on 04/21/2022 03:53 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:ABILITYFIRST - LAWRENCE L. FRANK CENTERFACILITY NUMBER:
198602059
ADMINISTRATOR:PRIVITT, KELLYFACILITY TYPE:
775
ADDRESS:201 S KINNELOA AVETELEPHONE:
(626) 449-5661
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 36CENSUS: DATE:
06/30/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Michael Barkyoumb - Facility Director
April Stover - Senior Program Director 		TIME COMPLETED:
05:45 PM
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Licensing Program Analyst(s) (LPA) Mary Flores conducting an announced case management visit at the facility to conduct a physical plant inspection of the facility due to recent remodeling of the facility. LPA Flores met with Michael Barkyoumb, facility director and April Stover Senior Program director.

Facility is licensed to serve a capacity of (36) Developmentally Disabled Ambulatory Adults, of which (8) may be Non-Ambulatory, none have restricted healthcare conditions. The client staff ratio is 1:3. This is a center based program with a focus on independence, community inclusive transitional living, leisure activities, money management, vocational skills training, and AbilityFirst Explore Ability program. Fire Clearance was conducted on 4/16/21.
Facility's tour consisted of 4 offices, 1 college to career office, 1 conference room, 1 staff lounge, 1 client activity room, 1 shared client/child activity room, 1 isolation room, 3 client bathrooms, 1 client change room/bathroom, a kitchen, a flex shared client/child room. LPA tested water temperature in bathroom #1 and bathroom #3 and were tested between 105.2 and 115.6 degrees F which is within the required 105 - 120 degrees F. Meal preparation will be facilitate and knives/sharps will be kept lock in a drawer to the right of the stove. Cleaning supplies and disinfecting will be kept lock in a cabinet across the stove. Refrigerators temperature was observed at 33.8 and 33.9 degrees F.
Facility will be sharing space area with licensed child care center but will not be commingling adults or children. Adult Day program hours are from 8:30am to 1:30pm and child care center hours are from 2:00pm to 6:00pm. Some staff will be shared between programs. Senior program director April Stover stated all staff are fingerprint through children index and become associated to all programs. LPA observed an interlaced fire carbon monoxide alarm throughout the facility. Device Outdoor area has sitting space and umbrellas have been order to provide additional shade outdoors. LPA has been provided with a copy of order receipt and will email a picture once umbrellas are installed.
(CONTINUED ON LIC 809C)
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2021
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ABILITYFIRST - LAWRENCE L. FRANK CENTER
FACILITY NUMBER: 198602059
VISIT DATE: 06/30/2021
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Facility is currently following COVID 19 recommendations for cleaning and disinfecting high touched areas, screening and maintaining logs, has a 30 day amount supply of PPE supplies and will provide PPE supplies in isolation area. Bathrooms have hand washing signs, paper towels, and soap. COVID related signs are posted throughout the facility.

Exit interview was conducted with Michael Barkyoumb Facility director and April Stover Program director and a copy of this report was provided.
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
LIC809 (FAS) - (06/04)
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