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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602094
Report Date: 01/27/2022
Date Signed: 01/27/2022 11:45:28 AM

Document Has Been Signed on 01/27/2022 11:45 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VILLA ESPERANZA SERVICES (DIMENSIONS)FACILITY NUMBER:
198602094
ADMINISTRATOR:CLAUDIA CORTEZFACILITY TYPE:
775
ADDRESS:1990 EAST WALNUT STREETTELEPHONE:
(626) 449-2919
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 65CENSUS: 49DATE:
01/27/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Damion Jackson - Case Coordinator
Claudia Cortez - Program Manager 		TIME COMPLETED:
12:00 PM
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Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on the infection control domain. LPA Flores met with Damion Jackson Case Coordinator and explained the reason for the visit. Claudia Cortez Program Manager arrived about 15 minutes.

This facility is licensed as an adult day program to serve a capacity of (65) Developmentally Disabled Adults age 18 to 59. The staff consumer ratio is 1:3 and some of the consumers receive 1:1 supervision. The last fire/emergency disaster drill was conducted on 12/20/2021. Facility has a lobby, a conference room, 3 offices, 4 classrooms, an activity room, a community room 2 participant restrooms, a kitchen, a copy room, a staff's restroom. Facility has a wired fire system throughout the facility. All participants are receiving virtual services at the time.
LPA Flores conducted a tour of the facility and observed the following:
Fire extinguishers were observed and last checked on August 2021.
Building, classrooms, and equipment is in good conditions.
Restrooms are in working condition, soap, paper towels, and hand-washing signs were observed and water temperature was tested at 113.2 degrees F. in the women's restroom and at 114.4 degrees F. in the men's restroom.
Facility keeps cleaning and disinfecting solutions locked in a cabinet in the sink and medication is locked in a cabinet in the kitchen. Medication was not reviewed as there are no clients attending in person at the facility. LPA Flores reviewed files for 2 staff and 4 participants.
Facility is currently following COVID 19 guidelines related to screening staff/participants/visitors. Signs were posted in the community room, LPA advise to place additional signs throughout. PPE supplies were observed for at least 30 days. Cleaning and sanitizing is done after each use of areas. Facility does not have an isolation area set and staff have not been fit for a proper N95 mask.
No deficiencies were given during this visit. Technical advisories were provided for COVID guidelines.
Exit interview was conducted with Claudia Cortez Program Manager and a copy of this report and technical advisory notes was provided.
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2022
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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