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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603499
Report Date: 10/31/2024
Date Signed: 10/31/2024 01:44:45 PM

Document Has Been Signed on 10/31/2024 01:44 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:SPOELSTRA LLC DBA VOICE LA PUENTEFACILITY NUMBER:
198603499
ADMINISTRATOR/
DIRECTOR:		STOCK, PATRICIAFACILITY TYPE:
775
ADDRESS:13907 "D" E AMAR ROADTELEPHONE:
(909) 792-2428
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 100CENSUS: 67DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Quiana Price, DirectorTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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Licensing Program Analysts (LPAs) Mayra Cota and Noemi Galarza conducted the required annual inspection. LPAs met with Quiana Price (S1), Program Director and discussed the purpose of the visit.

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.
LPAs toured and inspected the facility using the CARE tools. LPAs toured the facility with Program Director Quiana Price and observed the following:

Facility consists of two connected buildings. On the north side, is a reception area, Program Director office, 5changing rooms, storage room and kitchen. The south side of the building includes Transportation Room, an additional changing room, Staff Locker Room, Arts Expression Room, Current Events Room and a small kitchen. The outdoor environment consists of a patio with a table and chairs for clients to use. The garden area was observed to be well kept. All passageways and walkways were observed to be free of obstructions. All areas of the facility were free of hazards. The facility does not have a pool or large bodies of water on premises. The program operates eleven transportation vans which are serviced regularly.

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 all bathroom sinks and temperature measured between 112.2 - 113.3 degrees F. Cleaning supplies and sharps were observed to be locked.
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. LPAs observed clients engaged in activities. Sufficient staff was observed at the facility to assist clients.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SPOELSTRA LLC DBA VOICE LA PUENTE
FACILITY NUMBER: 198603499
VISIT DATE: 10/31/2024
NARRATIVE
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LPAs observed seven fire extinguishes fully charged and operational. Smoke detectors were tested and observed to be fully operational. The facility is equipped with a sprinkler system and fire pull alarms. Last fire inspection was conducted on 11/29/2023. The last fire drill was completed in 10/17/2024 for staff and clients. A first aid kit/manual was observed in the facility with the required items. All clients and staff files are stored in locked cabinets in the Program Director's Office. Two refrigerators were observed to be operational and used for client snacks, drinks, and any food they may bring that needs to be refrigerated and stored. All medications were observed to be locked and not accessible to the clients. LPAs reviewed 8 client and 7 staff files.

During todays inspection 3 deficiencies were 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: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/31/2024 01:44 PM - It Cannot Be Edited


Created By: Mayra Cota On 10/31/2024 at 01:23 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: 10/31/2024

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
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Based on observation, the licensee did not comply with the section cited above in that Activity Room celiling AC fliter and vent were observed to be in disrepair. Nurse Room restroom missing ceiling light cover, men's restroom toilet missing seat cover (stall 3), right faucet in men's restroom does not dispense hot water. Patio gate door has a double-sided deadbolt that was observed unlocked, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2024
Plan of Correction
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Director agreed to submit picture proof evidence of repairs made to Activity Room celiling, Nurse Room restroom ceiling, men's restroom toilet stall, men's restroom right faucet hot water fixture, and patio gate door.
Type B
Section Cited
CCR
82087.2(a)(3)
Outdoor Activity Space
(a) If outdoor activity space is provided, it shall: (3) Provide a shaded rest area for the 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 in [ that the outdoor patio table had a broken umbrella, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2024
Plan of Correction
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Director agreed to submit picture proof that the patio umbrella was replaced.
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:Mayra Cota
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/31/2024 01:44 PM - It Cannot Be Edited


Created By: Mayra Cota On 10/31/2024 at 01:23 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: 10/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on record review, the licensee did not comply with the section cited above in that staff (S1 & S4) heatlh screening did not contain TB clearance documentation, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/14/2024
Plan of Correction
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Director agreed to submit a copy of staff (S1 & S4) TB clearance.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mayra Cota
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2024


LIC809 (FAS) - (06/04)
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