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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603499
Report Date: 11/15/2022
Date Signed: 11/15/2022 12:55:34 PM

Document Has Been Signed on 11/15/2022 12:55 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:SPOELSTRA LLC DBA VOICE LA PUENTEFACILITY NUMBER:
198603499
ADMINISTRATOR:STOCK, PATRICIAFACILITY TYPE:
775
ADDRESS:13907 "D" E AMAR ROADTELEPHONE:
(909) 792-2428
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 100CENSUS: 100DATE:
11/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Patricia Stock -Program Director TIME COMPLETED:
01:03 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) Alberto Lopez, conducted an unannounced visit to the facility for purpose of an annual inspection. LPA met with Patricia Stock - Program Director and explained the purpose of the visit. Last fire drill was 09/27/2022 Emergency plan was posted.

Structure:
Facility consists of two sides of the building. On the North side, it includes the reception area, 2 small bathrooms and 2 large restrooms. Program Director office, Educational Equipment/Main Room, Pre-Vocational and Health Living Room, LVN office/Treatment room for client to rest, Program Director Assistant office, General Store, Life Skills Room, Client’s lockers, two changing rooms, storage room and kitchen. For the South side, it includes Transportation room, Staff Lockers room, Arts expression room, Changing room, Current Event Room, and a little kitchen. There's also a patio with tables and chairs for clients to use. The passageways and walkways are free of obstruction. All the front, back and side areas are free of hazards.

The following were observed/inspected:

· COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept


· LPAs was screened for this visit.
· Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote hand washing, cough/sneeze etiquette, and physical distancing.
· Facility does not have one designated isolation room due to remote services provided. All rooms were inspected.
· Facility was equipped with alcohol based hand sanitizer throughout facility.
· Four (4) centrally stored client medication records were reviewed. Only 4 clients take medication at day program
· Staff responsible for direct care and supervision were observed wearing masks.
· Clients were not observed wearing masks but adhering to public health social distance guidelines.
· Meal are not serveed at facility, client’s bring their lunch. Deficiencies cited, please see 809D for details.

Exit interview conducted with Patricia Stock - Program Director and copy of report provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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 3
Document Has Been Signed on 11/15/2022 12:55 PM - It Cannot Be Edited


Created By: Alberto Lopez On 11/15/2022 at 12:23 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: SPOELSTRA LLC DBA VOICE LA PUENTE
FACILITY NUMBER: 198603499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
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. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

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 one count as LPA and program director observed a pair of scissors on the craft table that had pointed end and accessible to clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2022
Plan of Correction
1
2
3
4
The scissors were put away during the time of visit.

****no further actions required at this time****
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:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/15/2022 12:55 PM - It Cannot Be Edited


Created By: Alberto Lopez On 11/15/2022 at 12:23 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: SPOELSTRA LLC DBA VOICE LA PUENTE
FACILITY NUMBER: 198603499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2022

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
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in one count as LPA and program director observed the decorative thin slab at the end of the men's restroom sink was coming unglued which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/29/2022
Plan of Correction
1
2
3
4
Licensee will repair or replace the thin slab by POC date and send proof to LPA via email.
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:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022


LIC809 (FAS) - (06/04)
Page: 3 of 3