Facility Evaluation Report

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted a Required One (1) year annual visit and inspection. LPA met with Co-Administrator and Direct Support Professional (DSP), Angelica Campos gained entry, explained the reason for the visit.

At 10:25a.m., Co-Administrator and LPA conducted physical plant tour inside and outside. Required posting observed in facility in the hallway. The smoke alarms are operational that are located in each bedroom, hallway and command areas. There are carbon monoxide detectors that functions properly. The fire extinguishers are located in the kitchen, front and back hallway. The charge date is 04/09/2024. During the visit the facility is at 73 degrees Fahrenheit.

The facility is licensed for an Adult Residential Facility, capacity of two (02) non ambulatory and six (06) ambulatory developmentally disabled clients. Facility is vendor through San Gabriel Pomona Regional Center as level 4E home. Facility has four (04) bedrooms and two (02) bathrooms for clients and staff. There are two (02) rooms upstairs locked at all times that are used for storage and staff office. The facility is a two-story home that in a residential community. There is no body of water in the facility. Fire and Earthquake Disaster drill was last conducted on 11/12/2024. Four (04) clients are at Day Program and three (03) clients at the facility waiting for a physician to visit them.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA observed at least two (02) days perishable and seven (07)