Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with Staff, Mateo Amor. House Manager, David Daquioag, arrived shortly thereafter to assist with the visit. The facility is licensed to serve (5) developmentally disabled clients ages 18 - 59, of which 2 may be non-ambulatory.

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

Infection Control: Facility is continuing to clean and disinfect on every shift and more often if needed. They are performing proper hand hygiene and using PPE supplies when necessary. The facility has an Infection Control Plan in place.

Physical Plant & Environment Safety: There is no swimming pool on the premises or items obstructing the walkways. There are 4 client bedrooms, 2 bathrooms, living room, dining room, kitchen, and attached garage. The outdoor area consists of a shaded area for clients to use. The fireplace is not in use and is secured by a fence. Smoke alarms and carbon monoxide detector are operable. Fire extinguisher was last inspected on 2/14/23. Knives, cleaning solutions, and disinfectants are locked and inaccessible to client. The hot water temperature was measured and is within the required range of 105 – 120 degrees F.

Operational Requirements: The fire clearance is approved for (5) clients and facility is operating within their requirements. There are currently 3 ambulatory and 2 non-ambulatory clients at the home, receiving services through the San Gabriel/Pomona Regional Center.

Staffing : There is sufficient staffing at the facility. Staff employed are over the ages of 18 and are fingerprint cleared and associated to the facility.

Personnel Records-Training : Staff files are maintained at the facility. LPA reviewed 3 staff files and they have the required documents such as current First Aid/CPR certification and Health Screening forms with Tuberculosis test results.