Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Yolanda Ramirez one of the caregivers at the facility. Facility administrator Jose Alderete was notified of the inspection over phone. There are two (2) ambulatory developmentally disabled clients who reside in the home. The facility is an Adult Residential Facility (ARF) vendored by the San Gabriel/Pomona Regional Center.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

· Infection control practices and Personal Protective Equipment (PPEs) were observed. The shared staff room may be used as a COVID-19 isolation room if necessary. The Facility administrator Jose Alderete advised that he will email his Infection Control Plan to LPA within 7 days.

· The facility is a single-story home located in a residential neighborhood that is licensed for a capacity of three (3) developmentally disabled clients, of which one (1) may be non-ambulatory. It consists of 3 client bedrooms, a staff room, a living room, dining room, a kitchen, one (1) shared client bathrooms of which the non-private restroom R#1 measured at 114.7 degrees F and private restroom connected with a staff room R#2 Measured 111.5 degrees F, backyard area, and an attached garage.