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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602053
Report Date: 09/08/2022
Date Signed: 09/08/2022 03:54:07 PM

Document Has Been Signed on 09/08/2022 03:54 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:CLIMB'S PRIDEFACILITY NUMBER:
198602053
ADMINISTRATOR:HECTOR VARGASFACILITY TYPE:
740
ADDRESS:207 WEST CARTER AVENUETELEPHONE:
(626) 355-1447
CITY:SIERRA MADRESTATE: CAZIP CODE:
91024
CAPACITY: 6CENSUS: 6DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Staff / Martha Ramos
Staff / Wendy Vasquez
Administrator / Hector Vargas		TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPA discovered there was no one present. LPA called Administrator / Hector Vargas (cell) and shortly after Mr. Vargas and Staff members / Martha Ramos and Wendy Vasquez arrived at the facility and assisted with the visit. The facility is licensed to serve six (6) Non-ambulatory Residents ages 60 and over. Currently, there are six (6) residents in placement. The facility is vendored with the San Gabriel/ Pomona Regional Center, level RCFE 4C. Climb's Pride does not have an approved Dementia Care Plan in their plan of operation and does NOT be accept or care for residents with dementia. LPA used the infection control domain to complete the Required - 1 Year inspection. Also, the physical plant was toured, medication and food supplies reviewed.

The facility is located in a residential area. A tour of the single-story facility includes: (3) resident bedrooms, (2.5) resident bathrooms, living room/ office area, dining room, kitchen, laundry room/ pantry, (2) backyards that includes (2) umbrellas with (table and chairs). All medications for residents who need assistance are kept locked and inaccessible to other residents.

The bathrooms are clean and operational. Resident bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The hot water temperature was tested throughout the facility and measured within Title 22 Regulation guidelines. The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in a secured cabinet and inaccessible to clients. The first-aid kit is fully stocked w/First-aid Manual. LPA reviewed resident medications.

Smoke detectors and carbon monoxide detectors are operable and in compliance. The fire extinguishers (2) were observed to be fully charged and in compliance. There is a functioning telephone on the premises.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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 2
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'S PRIDE
FACILITY NUMBER: 198602053
VISIT DATE: 09/08/2022
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The facility has central AC and heating accommodations. The washer and dryer are located in the pantry. A shaded area with chairs is provided in the back yard. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. The outdoor activity area is free of visible hazards and debris and the trash cans have covered lids. There are no security bars or weapons on the premises. There is no evidence of bodies of water (pool) on the premises. All required documents are posted inside the facility.
During today's walk through, LPA observed COVID-19 prevention/protocol signs posted throughout the facility.

Per Title 22 Regulations, there were no deficiencies observed during this visit.


An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
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