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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603314
Report Date: 05/28/2024
Date Signed: 05/28/2024 03:12:55 PM

Document Has Been Signed on 05/28/2024 03:12 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/
DIRECTOR:		CUEVAS, MIRIAMFACILITY TYPE:
775
ADDRESS:843 W GLENTANA ST.TELEPHONE:
(909) 335-3022
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 45CENSUS: 20DATE:
05/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:48 AM
MET WITH:Laura Bradshaw, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:15 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 Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. LPA explained the purpose of the visit to Administrator Laura Bradshaw. The Day Program is licensed to serve 45 non-ambulatory developmentally disabled adults ages 18 and over. It is vendored by San Gabriel/Pomona Regional Center. The facility does not provide transportation services. Clients bring their own meals and snacks. Facility operates on-site day programming. Twelve (12) Adult CARE tool domains were utilized with the inspection.

Infection Control:

  • The facility has an Infection Control Plan and COVID-19 Mitigation Plan. Infection control supplies were observed in storage areas.
Physical Plant/Environmental Safety:
  • Facility is a one story building located in a commercial/residential area equipped with central air conditioning and heating. The program consists of: 4 Activity rooms, 1 changing room, 3 [2 ADA] restrooms, 1 office, 1 relaxation room, and 1 break room. There is an outdoor grassy/shaded area without patio furniture. New patio furniture and umbrella have been purchased and were observed during the visit. Exit doors are free of any obstruction and there are no pools or large bodies of water. The building has battery operated smoke and carbon monoxide detectors, a fire pull-alarm system, and no sprinklers. Three (3) fully charged fire extinguishers were observed. There is an outdoor grassy/shaded area without patio furniture. New patio furniture and umbrella have been purchased and were observed during the visit. Exit doors are free of any obstruction and there are no pools or large bodies of water.
  • Water temperature readings did not between the required 105 - 120 degrees Fahrenheit. The facility maintains emergency food supply and water.
  • Emergency Phone numbers, exit plan and programming schedules were posted. First aid kits/Manual was observed and consisted of a thermometer, tweezers, scissors, antiseptic, bandages, gauze.
  • The main entry door is unlocked while day programming is done in the rear of the building. For safety reasons an alert and/or bell system at the front door entrance is recommended.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2024
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, INC
FACILITY NUMBER: 198603314
VISIT DATE: 05/28/2024
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
26
27
28
29
30
31
32
Operational Requirements:
  • The Program Design is not current. NOTE: The relaxation room is currently being used as the Director's office and the staff break-room is being used as a storage room.
  • Fire clearance has been approved for 45 non-ambulatory clients. The facility's last fire inspection was conducted on 1/9/2024 by the West Covina Fire Department.
  • Care and supervision to meet the clients needs was observed.
  • The facility does not handle client's monies and does not have a Surety Bond.

Staffing:
  • A total of 6 staff members provide care and supervision to the clients.

Personnel Records/Staff Training:
  • Five (5) staff files were reviewed for criminal background clearance and training, health/TB screenings, certifications, and 1st Aid/CPR training. Staff (S2 & S3) do not have health screenings/TB test results on file and staff (S4) does not have current 1st aid/CPR training.

Client Rights/Information:
  • Personal rights were observed in client files.

Client Records/Incident Reports:
  • Six (6) client files were reviewed and were observed to be complete. They contained ISP, IPP, medical assessments, and TB clearance.

Food Service:
  • There is a staff kitchen and a client kitchen that were observed to be clean and sanitary. No sharp objects are kept in the facility. Clients bring their own lunch, but snacks and meals are provided if needed.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, INC
FACILITY NUMBER: 198603314
VISIT DATE: 05/28/2024
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
26
27
28
29
30
31
32
Health Related Services:
  • The facility does not have any clients that require centrally stored medications.

Incident Medical and Dental:
  • All clients have Individual Services Plans on file, and Physician's Reports on file.
  • Staff training was observed.

Disaster Preparedness, and Emergency Intervention:
  • The facility has an Emergency Disaster Plan LIC 610D containing emergency evacuation information. However, sections H-I are missing information details. A technical violation was issued.
  • An emergency drill was conducted on 4/22/2024, within the last 6 months as required.


Emergency Intervention:
  • No manual restraints or seclusion are used with clients in car

Deficiencies were cited. See LIC9099D pages.

Exit interview conducted with Administrator Laura Bradshaw. A copy of the report and appeal rights were issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 05/28/2024 03:12 PM - It Cannot Be Edited


Created By: Noemi Galarza On 05/28/2024 at 02:27 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: ADULT BASIC LEARNING ENVIRONMENT, INC
FACILITY NUMBER: 198603314

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024

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
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that hot water readings ranged between 86.6 - 120.2 DF, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/29/2024
Plan of Correction
1
2
3
4
Administrator shall submit a water temperature log with water readings tested 3 times tomorrow, as well as picture proof of hot water temperature readings of all restroom and kitchen faucets.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 05/28/2024 03:12 PM - It Cannot Be Edited


Created By: Noemi Galarza On 05/28/2024 at 02:27 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: ADULT BASIC LEARNING ENVIRONMENT, INC
FACILITY NUMBER: 198603314

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(i)
Buildings and Grounds
(i) Rooms or areas for rest periods shall be provided.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above by changing the relaxation room into the Director's office without notifying CCL of Plan of Operation/physical plant changes, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/11/2024
Plan of Correction
1
2
3
4
Administrator shall submit a written plan of correction that states how it will be corrected.
Type B
Section Cited
CCR
82065(g)(1)
Personnel Requirements
(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that staff (S2 & S3) do not have health screenings/TB test results on file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/11/2024
Plan of Correction
1
2
3
4
Administrator shall submit a copy of S2 & S3's Health Screening/ TB test by POC due 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:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2024


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 05/28/2024 03:12 PM - It Cannot Be Edited


Created By: Noemi Galarza On 05/28/2024 at 02:27 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: ADULT BASIC LEARNING ENVIRONMENT, INC
FACILITY NUMBER: 198603314

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82075(f)
Health-Related Services
(f) Staff responsible for providing direct care and supervision shall receive and maintain current training in first aid and cardiopulmonary resuscitation from persons qualified by agencies including, but not limited to, the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that staff (S4) does not have current 1st aid/CPR training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/11/2024
Plan of Correction
1
2
3
4
Administrator is to ensure that a current First Aid certificate by the American Red Cross is kept on file for all staff who interact directly with clients in care. Administrator agreed to send LPA photographic proof of this training by the POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2024


LIC809 (FAS) - (06/04)
Page: 6 of 6