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 Administrator Marcos Hernandez and subsequently conducted a tour of the facility. There are three (3) ambulatory and one (1) 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. There is a visitor sign-in station at the entrance of the facility. Each individual client bedroom may be designated COVID-19 isolation room if needed. The facility does have an Infection Control Plan and the administrator emailed to LPA Zaragoza while at the facility.

· The facility is a single-story home located in a residential neighborhood that is licensed for two (2) non-ambulatory and two (2) ambulatory clients. It consists of 3 client bedrooms, a living room, dining room which is also an activity room, a kitchen, 2 (two) bathrooms of which the non-private restroom R#1 measured at 109.2 degrees F and private restroom in the master shared bedroom R#2 Measured 112.6 degrees F, backyard area, and an attached garage.