Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted subsequent annual inspection on 9/24/2024. LPA Ramirez was greeted by House Manager Teri Austin and LPA explained purpose of today’s visit.

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

Emergency Intervention: Facility staff are trained in Crisis Prevention & Intervention Training. Facility staff do not foresee the future use manual restraints or have a seclusion room in the facility.

Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drill was conducted on 09/23/2024 at 5:45 pm. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in garage.

Health Related Services/Incidental Medical Services: The medications are centrally stored and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. The facility provides incidental medical services.

Staffing: Administrator Certificate for Kimberly Allen and expires 3/1/2026. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility.

Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for three (3) out of the three (3) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel records reviewed.

Client Records/Incident Reports: LPA reviewed client records for three (3) clients in care. Client records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Individual Program Plan (IPP), and Resident Rights were observed. All clients receive services from San Gabriel/Pomona Regional Center.

No deficiencies were observed during visit. Exit interview conducted. A copy of this report was provided