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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602128
Report Date: 05/16/2023
Date Signed: 05/16/2023 03:38:44 PM

Document Has Been Signed on 05/16/2023 03:38 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: 23DATE:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Administrator Amed FrancoTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Jose Villalobos made and unannounced Annual inspection focused on domains within the Compliance and Regulatory Enforcement (Care) Tools. LPA met with Administrator Amed Franco and discussed the purpose of today's visit.

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. This program has the following: (2) Vocational rooms for skill learning assignments, (1) kitchen, (1) exercise area, (1) computer room, (5) restrooms and (1) office. Storage lockers for both staff and clients observed.

The following were observed/inspected: .
Physical Plant: Outdoor and indoor passageways are free of obstruction. Bathrooms were clean and operational, water temperature in compliance. Smoke/carbon monoxide detectors were tested and operational. Fire extinguisher observed. Required postings observed. Central Air and Heating with temperature comfortable. Emergency supplies observed. Toxins and sharps locked and inaccessible to clients. MEDICATION: Medications are stored, locked and inaccessible to clients who bring medication to site. RECORD REVIEW: Six (6) Staff Files reviewed. Six (6) client files reviewed. Staff on site meet ratio set by regional center. ACTIVITIES: LPA observed activities for client use as well as sufficient space and accommodations for clients to do activities.

Care Tool was completed and based on Title 22 Regulations, no Deficiencies will be documented.

An exit interview was conducted and a copy of today's report was provided and discussed.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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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