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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603499
Report Date: 11/20/2023
Date Signed: 11/20/2023 03:18:04 PM

Document Has Been Signed on 11/20/2023 03:18 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: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: 70DATE:
11/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Program Director -Quiana PriceTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Nune Margaryan conducted the unannounced annual inspection. LPA met with Program Director Quiana Price who assist with the visit. The purpose of the visit was explained.
The facility is an Adult Day Program (ADP) licensed to serve 100 developmentally disabled clients which may be non-ambulatory. The facility is vendorized through San Gabriel/Pomona Regional Center.
LPA toured and inspected the facility using the CARE tools. LPA toured the facility with Program Director Quiana Price and observed the following:
Facility consists of two side of the building. On the North side, it includes the reception area, 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, Clients 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. There is no pool or large body of water at the premises.
There are 3 bathrooms at the facility. All bathrooms are clean and sanitary, have a working toilets, wash basins, and they are able to accommodate for non-ambulatory clients in a wheelchair.
The water temperature tested in the bathroom's sink at 126.4 degrees F.
Infection control signs and other COVID-19 signs are posted at the entrance and throughout the facility in the bathrooms, kitchen, and hallway to promote hand washing, cough/sneeze etiquette, and physical distancing. All rooms were inspected. LPA observed clients are activity engage with the activities. There is a enough staff at the facility to assist the clients. LPA observed one bottle "Meguiar's Quik Wax" spray in the metal cabinet for the activity supplies unlocked and accessible to the clients.

Cont. 809C

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: SPOELSTRA LLC DBA VOICE LA PUENTE
FACILITY NUMBER: 198603499
VISIT DATE: 11/20/2023
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LPA observed five fire extinguisher and all five were fully charged. The smoke/carbon monoxide detectors were tested and observed to be fully operational. The last fire drill was completed in 10/04/2023 for the community center. A first aid kit was observed in the facility with the required items and a first aid manual was available. All clients and staff files are stored in the locked cabinet in the Program Director Office. Two refrigerators were observed at the facility, to be operational and will be used for consumer snacks, drinks, and any food they may bring that needs to be stored. All medications were observed to be locked and not accessible to the clients. LPA reviewed 5 clients and 5 staff files and interviewed 5 clients and 5 staff.
During todays inspection 2 deficiencies observed. See 809D for details.

An exit interview was conducted with Program Director Quiana Price and a copy of the report was provided along with appeal rights. .
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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Document Has Been Signed on 11/20/2023 03:18 PM - It Cannot Be Edited


Created By: Nune Margaryan On 11/20/2023 at 02:44 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: 11/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
(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
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Based on observation, the licensee did not comply with the section cited above. LPA observed chemical spray not locked and accesable to the clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/20/2023
Plan of Correction
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Staff iimmediately remove the solution and locked in the cabinet.
No further actions needed.
Type A
Section Cited
CCR
82088(e)(1)
(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
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Based on observation, the licensee did not comply with the section cited above water temperature tested in bathroom's sink at 126.4 degrees F., which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/20/2023
Plan of Correction
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Water temperature were adhusted at the time of visit.
Licensee will ensure water temperature is maintain within the required 105-120 degrees F.
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:Wei Siew Ho
LICENSING EVALUATOR NAME:Nune Margaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2023


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