Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 01/26/2024. LPA was met by Licensed Vocational Nurse- Sebastian Flor and explained the purpose of the visit. This facility is licensed as an Adult Residential Facility for Persons with Special Healthcare Needs (ARFPSHN) and receives services from San Gabriel/Pomona Regional Center. The facility is licensed to serve five (5) developmentally disabled clients ages 18 and above; of which five (5) may be bedridden. During today’s visit, LPA Ramirez observed one (1) Respiratory Therapist, one (1) Licensed Vocational Nurse and two (2) Direct Support Staff.

Kitchen: LPA Ramirez observed appliances to be clean and in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located kitchen cabinet, to be inaccessible to three (3) out of three (3) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to three (3) out of three (3) clients in care. Signs promoting hand washing were observed in this area. Meal plan was observed in this area for one (1) client in care.

Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed plenty of seating and lighting.

Linen Closet: Contained plenty linens, towels, and hygiene products.

Client Rooms 1 - 5: LPA Ramirez observed all resident bedrooms to contain the required linens, furnishings, and lighting. LPA Ramirez observed mechanical lifts in all client bedrooms and were observed to be in working order. LPA Ramirez observed caution signs indicating “oxygen in use” near entry of client rooms where oxygen was in use. Two (2) out of five (5) bedrooms are currently unoccupied. LPA Ramirez observed “treatment cart” in all client bedrooms.

Bathrooms: Water temperature in bathroom#1 was measured at 110.3 degrees F. Bathroom #2 water temperature was measured at 109.4 degrees F. Mechanical lift in bathroom# 2 was operable and tested during visit. LPA Ramirez observed a shower gurney in bathroom #2. LPA Ramirez observed three (3) individually labeled cabinets on nearby wall that contained individual hygiene products for each of the three (3) clients in care. All client bathrooms were observed to be clean and signs promoting hand washing were observed.