Facility Evaluation Report

On 7/07/2025 at approximately 10:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the Caregiver and stated the reason for their visit. The facility’s designee, Selva Banos arrived shortly after to assist with today’s visit but could not stay for the entirety, therefore designated the Caregiver to sign today’s report.

LPA asked for the census and Staff/Client Roster. LPA conducted a physical plant tour at approximately 12:00 PM and the following was noted:

The facility is a single-story building with five (5) bedrooms and two (2) bathrooms currently occupying four (4) clients. There is one (1) designated staff room. The facility has an approved fire clearance for four (4) ambulatory clients. The facility is vendor through North Los Angeles Regional Center (NLARC) and is being operated at a Level II Adult Residential Home. Sign-in sheet and hand sanitizer located upon entrance.

Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 73°F. LPA observed the fire extinguisher to be located near the kitchen and dated 10/31/2024. LPA observed required postings such as Rights of Individuals with Developmental Disabilities, See/Say Something and Facility License located throughout the common areas. A working telephone was observed.

Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. The kitchen appliances were observed to be working and in proper condition. The knives/sharps, medications and Staff/Client files were observed to be kept in a locked storage closet located within the hallway’s passageway and inaccessible to clients. (continued on LIC 809-C)