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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602852
Report Date: 02/26/2024
Date Signed: 02/26/2024 01:09:37 PM

Document Has Been Signed on 02/26/2024 01:09 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:PEOPLE'S CARE ROSEMEADFACILITY NUMBER:
198602852
ADMINISTRATOR:KRISTINE PANAMENOFACILITY TYPE:
775
ADDRESS:1280 SAN GABRIEL BLVDTELEPHONE:
(626) 802-5889
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY: 60CENSUS: 30DATE:
02/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Kristine PanemenoTIME COMPLETED:
01:19 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alberto Lopez conducted the required annual inspection using the CARE tools. Program Director, Kristine Panameno, assisted with the visit. LPA explained the purpose of the visit. The day program is licensed for 60 clients, ages 18-59, of which 18 may be non-ambulatory.

LPA toured the facility and inspected/observed the following:

Infection Control: The facility has sufficient supplies of PPE and utilizing gloves when necessary to assist participants. They are performing proper hand hygiene before and after caring for clients and providing snacks. Staff are cleaning and disinfecting surfaces regularly to keep the facility clean.
Physical Plant & Environmental Safety: The facility consists of a lobby area, ten (10) training/activity rooms {communication room, well-ness center, music studio, recreation, media center, creative studio, computer lab, independent living, home economics/kitchen, boutique}, 10 restrooms, 2 offices, storages rooms, and 3 exits. The facility is clean, sanitary, and LPA observed one torn screen outside. Disinfectants and cleaning solutions are properly stored and locked. The hot water temperature measured between 117.3 – 123.9 degrees F. which is out of range. There is water damage on the wall in the living skills room next to the kitchen area. One sink facet is loose in a restroom.
Operational Requirements: The facility is operating within the approved fire clearance.
Staffing: The staffing is maintained at a 1 staff to 3 participants as specified by the regional center.
Personnel Records - Training: LPA reviewed 4 Staff records and they have the required documentation in their files. The CPR/First aid certificates are current and associated to the facility. Staff are provided with in-service training at least once a month.
Client Records - Incident Reports: LPA reviewed 4 Client files and the files consist of the admission agreement, medical assessment with TB test result, consent forms, and current IPP.
Client Rights - Information: Participants do not utilize any postural supports.
Food Service: Clients bring in lunch from home daily and facility only provide snacks.

(continued).
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
Document Has Been Signed on 02/26/2024 01:09 PM - It Cannot Be Edited


Created By: Alberto Lopez On 02/26/2024 at 12:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PEOPLE'S CARE ROSEMEAD
FACILITY NUMBER: 198602852

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Water measured between 117.3 - 123.7 which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2024
Plan of Correction
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Facility will adjust water temperature and send proof and self certify that it has been adjusted to LPA by POC date
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 02/26/2024 01:09 PM - It Cannot Be Edited


Created By: Alberto Lopez On 02/26/2024 at 12:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PEOPLE'S CARE ROSEMEAD
FACILITY NUMBER: 198602852

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, and interview, the licensee did not comply with the section cited above. One room showed evidence of water damage which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/11/2024
Plan of Correction
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Facility Director will repair water damage send proof to LPA by POC date.
Type B
Section Cited
CCR
82088(b)
Fixtures, Furniture, Equipment, and Supplies
(b) All window screens shall be in good repair and be free of insects, dirt and other debris.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. One window screen was torn and needs repair or replacement which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/04/2024
Plan of Correction
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Facility Director will repair or replace the torn screen and send POC to LPA by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 02/26/2024 01:09 PM - It Cannot Be Edited


Created By: Alberto Lopez On 02/26/2024 at 12:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PEOPLE'S CARE ROSEMEAD
FACILITY NUMBER: 198602852

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82088(e)(3)
Fixtures, Furniture, Equipment, and Supplies
(3) All toilets, hand washing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences shall be provided in day programs accommodating physically handicapped clients who need such items.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. One sink facet is loose and need to be repaired or replaced which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/04/2024
Plan of Correction
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Facility Director will repair loose facet send proof to LPA by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: PEOPLE'S CARE ROSEMEAD
FACILITY NUMBER: 198602852
VISIT DATE: 02/26/2024
NARRATIVE
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Health-Related Services: One client is taking medication during program hours and LPA reviewed file and MAR and meIIncidental Medical Services: The facility has one participant in attendance with a restricted health condition and LPA reviewed restricted Health Condition Care plan pending Regional Center approval.
Disaster Preparedness: Facility needs to updated LIC610D form with location and instructions of shut off valves.
Emergency Intervention: Staff have CPI training and do not utilize manual restraints at the site.



Deficiencies issued and technical advisory provided as well as appeal rights. A copy of this report was given to the Program Director
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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