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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602059
Report Date: 02/07/2023
Date Signed: 02/07/2023 11:10:10 AM

Document Has Been Signed on 02/07/2023 11:10 AM - 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: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: 34DATE:
02/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Krystal Rosales - Activity Coordinator TIME COMPLETED:
11:15 AM
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Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on infection control. LPA met with Krystal Rosales Activity Coordinator and explained the reason for the visit. Lisa Duenas Program Supervisor arrived 15 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, 2 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, 3 outdoor spaces.

LPA Flores conducted a tour of the facility and observed the following:
Facility is conducting screening for staff/clients upon arrival. It has one point of entry in the parking lot. Kitchen has a knives/sharp drawer kept under lock. LPA tested water temperature in kitchen sink at 105.8 degrees F. There are two (2) refrigerators and temperature reads at 34.0 and 40.0 degrees F., and one (1) freezer temperature reads at -1.0 degrees F. Clients lunch bags and snacks provided are stored in the facility's refrigerators. Cleaning supplies are kept in a lock cabinet in storage area and disinfecting supplies are throughout the facility in lock cases. Client areas are divided into pods with tables set up for 3 clients: 1 staff ratios. All rooms are clean and in good condition. Isolation room is maintain with PPE supplies outside the room and a closed lid trash can. All facility areas are clean and in good repair. Four (4) bathrooms were observed with hand washing signs, in good repair, and water temperature in each bathroom was tested between 98.8 - 113.1 degrees F. which is within the required 105- 120 degrees F. Facility has a fire alarm system with smoke/carbon monoxide detectors throughout the facility. Fire extinguishers are located throughout the facility and last checked on 11/22. Last emergency drill was conducted on 1/24/23. Outside patios have shaded sitting areas. Facility does not provide medication on site. LPA reviewed files for 3 staff and 3 clients.
No deficiencies were observed during this visit per Title 22. Exit interview was conducted with Michael Barkyoumb Director and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
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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