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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602094
Report Date: 02/27/2023
Date Signed: 02/27/2023 02:52:25 PM

Document Has Been Signed on 02/27/2023 02:52 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: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: 27DATE:
02/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Damion Jackson - Case CoordinatorTIME COMPLETED:
03:05 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. LPA Flores met with Damion Jackson Case Coordinator and explained the reason for the visit. Claudia Cortez - Program Director arrived 20 minutes later.

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 1:6 and some of the consumers receive 1:1 supervision .Facility has a lobby, a conference room, 3 offices, 6 classrooms, an activity room, a community room, 2 participant restrooms, a kitchen, a copy room, a staff's restroom. Facility is providing in person services to 24 participants and remote services to 3 participants.

LPA Flores conducted a tour of the facility with Damion Jackson Case Coordinator and observed the following:
Facility has a wired fire system throughout. All activity rooms are in good repair. Signs are posted in the activity room, community room, and in the classrooms. Participants and staff were observed wearing face mask and practicing social distancing during activities. Kitchen was observed, cleaning supplies and knives were under lock under the kitchen's sink. Men and women bathroom were observed and water was tested between 116.0 and 116.2 degrees F., which is within the required 105-120 degrees F. Client and staff/visitor's bathrooms have the appropriate signage, paper towels, and soap available. No medication is provided at the program and participants bring their lunches which are refrigerated in the refrigerators located in the kitchen. The last fire/emergency disaster drill was conducted on 1/17/23 and 1/19/23. Fire extinguishers were observed last checked on 8/3/22.

No deficiencies were noted during this visit.

Exit interview was conducted with Damion Jackson Case Coordinator and a copy of this report was provided.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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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