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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603314
Report Date: 06/07/2022
Date Signed: 06/07/2022 06:45:54 PM

Document Has Been Signed on 06/07/2022 06:45 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:ADULT BASIC LEARNING ENVIRONMENT, INCFACILITY NUMBER:
198603314
ADMINISTRATOR:CUEVAS, MIRIAMFACILITY TYPE:
775
ADDRESS:843 W GLENTANA ST.TELEPHONE:
(909) 335-3022
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 45CENSUS: 16DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 AM
MET WITH:Miriam Cuevas-Program DirectorTIME COMPLETED:
02:40 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 Analyst (LPA) Christine Wong conducted an unannounced annual visit at the facility. LPA met with Miriam Ceuvas - Program Director and explained the reason for the visit and assisted LPA with tour of the facility.

Facility is licensed to served 45 adults and approved for 45 non-ambulatory. Facility serves an adult day program capacity and is currently serving clients virtually and partially in person due to COVID 19. Facility has four activity rooms, three storage rooms, lobby area/ relaxation room, program director office, director office, changing room, three unisex bathrooms and a kitchen.

LPA conducted a tour of the facility with the program director and observed the following:
Restrooms water temperature were tested between 108.5 and 117.3 degrees F which is within the Title 22 regulation. Facility has 3 fire extinguishers were observed throughout the facility. Facility's first aid kit is stored in the 4th activity room in the back and the lobby area which has required items. Facility does not have any sharp utensils in the facility and the cleaning supplies are stored and locked in the storage room next to the kitchen which is inaccessible to the clients. Per Program Director, client would bring their own lunch and facility would provide snacks for clients. Currently, staff is not administering any medication for clients in the facility. LPA also inspected the smoke detectors/carbon monoxide detectors and they are located in each activity room and staff office and common area and they are working well.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, disinfecting products are available in each room and facility is disinfected twice a day. All restrooms have sufficient soap, paper towels, and hand-washing signs. PPE supplies are sufficient for more than 30 days.

No deficiencies were found during this visit. Exit interview was conducted with program director Miriam Cuevas and a copy of this report was provided.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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