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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602059
Report Date: 03/09/2022
Date Signed: 03/09/2022 01:01:38 PM

Document Has Been Signed on 03/09/2022 01:01 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: 37DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Edward Frutis - Case Manager
Michael Barkyoumb - Program Director 		TIME COMPLETED:
01:20 PM
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Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual inspection visit at the facility with focus on the infection control domain. LPA Flores met with Edward Frutis Case Manager and explained the reason for the visit. Program Director, Michael Barkyoumb arrived 20 minutes later.

This facility is licensed to serve a capacity of (36) Developmentally Disabled Ambulatory Adults, of which (8) may be Non-Ambulatory. Facility consists 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, 4 client bathrooms, 1 out of the 4 has client change room, a kitchen, a flex convert client/child room.

LPA Flores conducted a tour of the facility with Edward Fruits case manager and observed the following:
Kitchen area is utilized for teaching skills, staff keeps cleaning supplies and sharps lock in cabinet and drawers. Lunch bags are keep in large industrial refrigerators. Facility maintains snacks, and juices for participants. LPA Flores tested water temperature in kitchen sink at 109.6 degrees F. Flex room and convert shared client/child room have tables set up for 4 people, staff:client ratio 1:3. Staff were observed wearing face mask and face shields. Locked clear plastic boxes were observed in each area containing disinfecting wipes, and hand sanitizer. LPA Flores tested water temperature in bathroom #1 at 101.0, bathroom #2 at 95.0, bathroom #3 at 107.3, and bathroom #4 at 103.1 degrees F, which are not within the required 105 -120 degrees F. Facility is currently not assisting participants with medication, LPA did not review medication. Facility outdoor area provides shade sitting area. Facility is following all COVID19/infection control guidelines and recommendations. Last fire drill was conducted on 3/4/22, fire extinguishers were last inspected on 1/22/22. Facility has a sprinkler system throughout the facility.

A technical advisory was given during this visit.

Exit interview was conducted with Michael Barkyoumb Program Director and a copy of this report was provided.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2022
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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