Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Post Licensing Visit on 05/28/2024 at 8:56 am. LPA was met by Direct Support Personnel (DSP) Stacey Worrell and explained the purpose of the visit. Administrator This facility is licensed as an Adult Residential Facility for Persons with Special Healthcare Needs (ARFPSHN) and is vendorized by 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. LPA Ramirez observed one (1) Registered Nurse, two (2) Direct Support Personnel, and one (1) Licensed Vocational Nurse, providing direct care and supervision to clients. LPA Ramirez requested and obtained copies of personnel Report, and client Roster.

LPA OBSERVATIONS: Tour began at 9:07 am and was led by LPA Ramirez. The facility is a single-story home that contains five (5) bedrooms fully equipped with mechanical lifts, two (2) bathrooms of which one (1) is equipped with a mechanical lift, three (3) bathrooms, living room, TV room, kitchen, dining room, laundry room, staff office, backyard shaded patio area, and attached garage.

Front Yard: Was clean and well maintained. No hazards were observed. Passageways are free of any obstructions.

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 three (3) clients in care.