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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603560
Report Date: 07/27/2026
Date Signed: 07/27/2026 12:33:34 PM

Document Has Been Signed on 07/27/2026 12:33 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:CLIMB SIERRA MADRE RCFEFACILITY NUMBER:
198603560
ADMINISTRATOR/
DIRECTOR:		VARGAS, HECTORFACILITY TYPE:
740
ADDRESS:161 W. SIERRA MADRE BLVD.TELEPHONE:
(626) 355-1447
CITY:SIERRA MADRESTATE: CAZIP CODE:
91024
CAPACITY: 40CENSUS: 38DATE:
07/27/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:54 AM
MET WITH:Hector Vargas - AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced required- 1 year visit. LPA met with Patricia Wong, Wellness Coordinator and explained the purpose of the visit. Shortly after, administrator, Hector Vargas arrived and and assisted LPA. The facility is approved to serve residents age range 60 and over, approved for capacity of (40) residents of which (30) ambulatory and (10) non ambulatory; approved hospice waiver for (5) hospice residents. The facility provides care and support services primarily tailored for blind and visually impaired adults. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained on the emergency infection control plan and following hand hygiene techniques. Emergency Infection Control Plan was reviewed and updated on 01/26/2026.


Operational Requirements: Facility does not accept nor retain residents with dementia. Plan of Operation was reviewed and the Infection Control Plan has been added to the Plan. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 07/15/2027. Fire drill was last conducted on 07/15/2026.
Physical Plant/Environment Safety: The facility is a single story building located in a commercial area. The facility consists of (2) separate buildings: 1st building (single story) consists of (20) resident rooms and (14) bathrooms, (5) community shower room, laundry room, outside patio, medication room, living room/receiving area, dining area, kitchen and pantry. 2nd building in the back (2 story): 1st floor consists of administrative office, conference room, storage room, detached garage. 2nd floor consists of accounting office and medical office. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The facility is equipped with cameras in the common areas. The bathrooms were observed to be clean and operational. Cleaning supplies and toxic substances are inaccessible to residents. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit, bathroom #1 (107.1 deg F) and bathroom #2 (112.8 deg F). The kitchen was observed to have sufficient amount of perishable and non-perishable food supplies. LPA observed perishable food was stored in covered containers at the appropriate temperatures. There are cameras without audio in the common areas. Fire extinguishers were observed throughout the facility and were last serviced on 04/21/2026. Smoke detectors, fire sprinklers and pull fire alarm system observed and hard wired to the City of Sierra Madre Fire Department. *****CONTINUED ON LIC809-C*****
Lisa Hicks
Bennette Pena
DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: CLIMB SIERRA MADRE RCFE
FACILITY NUMBER: 198603560
VISIT DATE: 07/27/2026
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Staffing: There are sufficient staff to provide care and supervision to the residents, including the Administrator. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Administrator's certificate is valid, expires on 06/23/2028.
Personnel Records-Training: LPA reviewed (5) staff files. Proof of staff training, Health clearance, Fingerprint/Clearance exemptions, Criminal Record statement, Vaccinations and 1st Aid/CPR training are current.
Resident Rights-Information: Resident personal rights, complaint hot line information and visitors policy posters are posted. Facility provides internet services to all residents and have access to the facility's special phone and tablet.
Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. LPA observed sufficient equipment and supplies to accommodate residents with special needs to meet the requirements of the activity program. Monthly activity calendar is posted. The facility has a Resident Council and council members/residents meet on a monthly basis. Last meeting was held on 07/23/2026.
Food Service: Sufficient food supply is stored in the kitchen and pantry area consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies are stored in a separate building. Pesticides and cleaning supplies are kept away from the food preparation areas. Staff wear hairnets and disposable gloves while preparing food. Kitchen has a dietary board indicating residents' modified and/or restricted diet list.
Incident Medical and Dental: Facility has (3) medical carts where residents' medications are stored in their original containers (mostly bubble packed). Medications were reviewed to ensure they are given as prescribed and documented properly. Medications are administered as prescribed by the Physician. The facility uses the Medication Administration Record (MAR) log to document medications given.
Resident Records/Incident Reports: (5) resident files were reviewed. They contained Admission Agreements, Physician's Reports, Pre Placement Appraisal, TB clearance, IPPs, Functional Capability Assessment, Physician's Orders, Medical Consent, Medication Records.
Disaster Preparedness: Emergency and Disaster Plan is in place, containing emergency evacuation, storage and preservation of medications, operation of manual assist devices.
Residents with Special Health Needs: There are (0) hospice residents. There are (2) residents with restricted health condition and currently receiving home health services. There are no residents with prohibited health conditions.

No deficiency cited. Exit interview and a copy of this report was provided to the Administrator, Hector Vargas.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
LIC809 (FAS) - (06/04)
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