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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603560
Report Date: 08/16/2022
Date Signed: 08/16/2022 11:58:58 AM

Document Has Been Signed on 08/16/2022 11:58 AM - 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:CLIMB SIERRA MADRE RCFEFACILITY NUMBER:
198603560
ADMINISTRATOR:VARGAS, HECTORFACILITY TYPE:
740
ADDRESS:161 W. SIERRA MADRE BLVD.TELEPHONE:
(626) 289-5321
CITY:SIERRA MADRESTATE: CAZIP CODE:
91024
CAPACITY: 40CENSUS: 38DATE:
08/16/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Executive Director / Hector VargasTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an announced follow up to the pre-licensing inspection conducted on 7/12/22. Upon arriving at the facility, LPA met with Executive Director / Hector Vargas who assisted with the visit. Licensee / Climb Inc., has submitted an application to operate a Residential Care Facility for the Elderly for a capacity of forty (40) residents, ages 60 and over. The facility has an approved fire clearance for thirty (30) ambulatory residents and ten (10) non-ambulatory residents only. Fire clearance was granted on 7/1/22. The new application is being processed as a change of facility type. There are currently thirty-eight (38) residents living at the facility. Licensee prefers to serve Developmentally Disabled Blind Residents. Climb Sierra Madre RCFE does not have an approved Dementia Care Plan in their plan of operation and will NOT be accepting or caring for residents with dementia.

During the initial pre-licensing inspection conducted on 7/12/22, the following concerns were observed;
  • The hot water temperature was tested throughout the facility and did not meet California Code of Regulations Title 22. The hot water temperature in room #12 was measured at 124.6 degrees F. The hot water temperature in room #24 was measured at 123.5 degrees F. The hot water temperature in room #40 was measured at 132 degrees F. The Executive Director was asked to ensure that the hot water temperature is maintained between 105 degrees F - 120 degrees F throughout the facility as required and submit a log for the next 24 hours showing the actual reading in rooms #12, #24 and #40. On 7/13/22, the Executive Director submitted a 24 hour log, showing the hot water temperature was adjusted in rooms #12, #24 and #40 and the reading was in compliance.
  • Also, during a walk through of the facility, LPA Katrdzhyan observed that the facility was not equipped with a signal system. Title 22 Regulations Section 87303 / Maintenance and Operation states;

    • (i) Facilities shall have signal systems which shall meet the following criteria.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CLIMB SIERRA MADRE RCFE
FACILITY NUMBER: 198603560
VISIT DATE: 08/16/2022
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    (1) All facilities licensed for 16 or more and all residential facilities having separate floors or
buildings shall have a signal system which shall:
    (A) Operate from each resident's living unit.
    (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory
signal at the living unit loud enough to summon staff.
    (C) Identify the specific resident living unit.

During today's visit, LPA toured the facility and tested the signal system installed in all resident rooms (with the assistance of the Executive Director) and the signal system was observed to be operational and in compliance with Title 22 Regulations Section 87303 / Maintenance and Operation.
The signal system was installed on 8/3/22.

No further action is needed at this time.
An exit interview was conducted and a copy of this report was provided to the Executive Director.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC809 (FAS) - (06/04)
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