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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603489
Report Date: 09/19/2024
Date Signed: 09/19/2024 05:57:29 PM

Document Has Been Signed on 09/19/2024 05:57 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:ABOVE AND BEYOND ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198603489
ADMINISTRATOR/
DIRECTOR:		SAUNDERS, TONYAFACILITY TYPE:
735
ADDRESS:430 S. MOUNTAINTELEPHONE:
(951) 323-3852
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 4CENSUS: 3DATE:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:52 AM
MET WITH:Adminstrator Kimberly Allen TIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection visit and was greeted by House Manager- Teri Austin. Administrator Kimberly Allen, arrived shortly after to assist with tour. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single story dwelling.
LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to clients, were observed to be inaccessible to clients. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected three (3) client rooms. All client bedrooms contained required furniture, linens and lighting. Blinds in client room #1 and #2 are broken. Staff advised LPA that due to C1 recent behaviors and C1 having a history of property destruction, LPA will issue technical violation. LPA Ramirez discussed alternative coverings for window in C1's bedroom due to his behaviors. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F.

Food Service: LPA Ramirez observed sufficient supply of nonperishable for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C).

Infection Control: Staff is using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place.



Operational Requirements: The facility is licensed to serve developmentally disabled adults aged 18- 59, years old. The facility may serve one (1) ambulatory and three (3) non-ambulatory clients. All clients in facility are receiving services from San Gabriel/Pomona Regional Center.

Due to a medical care appointment at the facility for C1, LPA Ramirez will return at a later date to complete annual inspection and review records.

One (1) technical violation was observed. A copy of this report, LIC 9102 and appeals rights was provided via email. Exit interview was conducted with Administrator Kimberly Allen.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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