<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602919
Report Date: 09/22/2021
Date Signed: 09/22/2021 11:47:43 AM

Document Has Been Signed on 09/22/2021 11:47 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:VOCATIONAL INNOVATIONSFACILITY NUMBER:
198602919
ADMINISTRATOR:FRANCO, AMEDFACILITY TYPE:
775
ADDRESS:2620 CALIFORNIA AVE STE C-FTELEPHONE:
(714) 576-2523
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY: 60CENSUS: 20DATE:
09/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Program Director: Celeste AbernathyTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Nune Margaryan and Joe Katrdzhyan conducted an unannounced Required - 1 Year annual inspection visit with the focus of the infection control domain. LPAs met with Celeste Abernathy and explained the purpose of the visit.
This day program is licensed for 40 ambulatory and 20 non-ambulatory Developmentally Disabled Adults, ages 18 through 59. There are 20 consumers attending the program today.

LPAs toured the facility at 10:10 am with assistance of Anthony Alvarez and the following were observed/inspected: Facility is located in a business complex. This is a large building with 4 Activity Rooms, 2 Relaxation Rooms (of which one of the Relaxation rooms maybe used as an isolation room if needed), Conference Room, Computer Room and a Kitchen. All rooms have required furniture and equipment necessary to conduct all activities. Proper COVID-19 signs are posted at the front door and throughout the facility. Documents are posted as mandated by Title 22 Regulations. Facility is equipped with a centralized sprinkler system. Tree (3) fire extinguishers are fully charged and in compliance. Facility has four (4) bathrooms which were observed to be clean, operational and have the required grab bars for non-ambulatory clients. The hot water temperature was tested throughout the facility and measured within Title 22 Regulation guidelines (116.1 F - 116.9 F). Disinfectants and cleaning supplies are stored in locked cabinets and in the kitchen and kept locked and inaccessible to the clients. The first-aid kit is fully stocked w/First-Aid Manual, thermometer, scissors, tweezers, bandages and sterile first-aid dressing. Medications are centrally stored and locked inside the office. Staff and clients on premises were wearing face coverings. Extra PPE supplies were observed locked in the storage room. There is one central entry point that has been designated to screen all clients, staff, and visitors. A check-in station is set up by the entrance and routine symptom screening is initiated at entry.

There were no deficiencies observed during this visit. An exit interviewed was conducted and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2021
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 1