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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602128
Report Date: 04/28/2022
Date Signed: 04/28/2022 12:43:29 PM

Document Has Been Signed on 04/28/2022 12:43 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:VOCATIONAL INNOVATIONSFACILITY NUMBER:
198602128
ADMINISTRATOR:PATEL, MANDAKINIFACILITY TYPE:
775
ADDRESS:1532 E SAN BERNARDINO B1-B5TELEPHONE:
(909) 971-3280
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 60CENSUS: 28DATE:
04/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Zaira Silva-Olguin (Program Director)TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced annual inspection. LPA met with Zaira Silva-Olguin (Program Director) and discussed the purpose of today's visit.

Due to COVID-19, this program currently provides services to a maximum of 10 clients on-site and the rest of the clients receive services remotely either by community visits or via Zoom. Most clients are on a rotated schedule. This program operates Monday through Friday from 8:00 AM to 4:00 PM and provides services for the developmentally disabled clients. All clients in this program receive case management services provided by San Gabriel Pomona Regional Center.

The following were observed/inspected: .
  • COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and throughout the facility. Signs to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.
  • PPE supplies observed. These items are stored inside storage room "J".
  • Restrooms have hand soap and hand sanitizer.
  • Per Program Director, (26) out of (28) clients are fully vaccinated including the booster.
  • Per Program Director, (9) out (13) staff are vaccinated in which (3) have the booster pending and will be receiving their booster soon. (4) out of (13) are not vaccinated and they have religious exemptions on file.
  • Medication reviewed for (2) Clients (C-1 and C-2).
  • Staff responsible for direct care and supervision will wear masks.
  • Clients were be socially distanced according to local public health guidelines.


Exit conducted, a copy of this report and appeal rights provided to Zaira Silva-Olguin.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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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