Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection visit and was greeted by Direct Support Staff. Administrator Maureen Jerica Acero, arrived shortly after to assist with tour. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single story dwelling.

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

Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to clients, were observed to be inaccessible to clients. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected four (4) client rooms. All client bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near showers and toilets. During inspection, LPA Ramirez observed three (3) out of four (4) light bulbs to be inoperable in bathroom #1. LPA Ramirez observed two (2) out of three (3) light bulbs to be inoperable in bathroom#2. Staff replaced bulbs during inspection.

Food Service: LPA Ramirez observed sufficient supply of nonperishable for one week. LPA Ramirez did not observe staple of fresh perishable foods for a minimum of two days, however, staff delivered fresh perishables during inspection. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C).

Infection Control: Staff is using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place.

Operational Requirements: The facility is licensed serve four (4) developmentally disabled clients 18-59 years old. The facility is a level VI G home and may care for four (4) ambulatory clients. All clients in the home receive services from San Gabriel/Pomona Regional Center.