Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 02/04/2023 at 8:55 am. LPA was met by Licensed Psychiatric Technician (LPT) Sheri Irabor and explained the purpose of the visit. At 9:26 am Administrator Joseph Jerome Estanislao later arrived to lead tour. Facility is licensed to clients 18 – 59 years old. The facility is licensed to served 4 non-Ambulatory clients. Clients at this facility receive services through San Gabriel Valley/Pomona Regional Center. LPA requested and obtained a copy of Personnel Report (LIC 500), Resident Roster (LIC 9020), and copy of Person/Family Centered Planning Individual Program Plan (IPP)

LPA OBSERVATIONS: Tour was given by LPT Irabor at 9:06 am. The facility is located on residential cul da sac. The facility contains front yard, enclosed yard, detached garage, kitchen, dining room/living room, shared client bathroom, linen closet, 4 client bedrooms, and 1 private client bathroom.

· Front Yard: Was clean and well maintained. No hazards were observed.

· Kitchen: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7 days of non-perishables. Kitchen sink water temperature was measured at 108.3 degrees F. Signs promoting hand washing and social distancing were observed. Sharps were secured in cabinet and inaccessible to clients.

· Dining Room/Living Room: Dining room area was clean, and LPA observed a table with 7 chairs. Living room area had 2 couches for seating. Signs promoting social distancing and cough/sneeze etiquette were observed throughout this area.

· Linen Closet: Contained plenty of linen and towels.