Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. Upon arrival, LPA met with DSP Nicole Lian, who assisted with the visit. LPA spoke with administrator, Maria Devore, over the phone. The facility served four (4) ambulatory and two (2) non-ambulatory developmentally disabled adults. Currently all clients are ambulatory and placed by San Gabriel/Pomona Regional Center. Administrator certificate's expiry date on 05/13/23. Annual fees are current. LPA discussed with administrator regarding the purpose of today's visit and the inspection.

During the visit, the following domain of the new inspection tool was used: infection control domain; a tour of the facility was conducted; food supply was reviewed; and medications were reviewed.

This is a single story home which consists of five (5) clients' bedrooms, three (3) bathrooms, living room, front room/staff office area, dining area, kitchen, attached garage used as game /exercise room with a back yard with tables and chairs. Stove burners, oven, microwave, washer, and dryer are all working well. There are two refrigerators in the home, one in the kitchen and one in the garage for additional food storage. Facility maintains the required two (2) days perishable and seven (7) days non- perishable. Clients’ bedrooms have beds, dresser, and closet space available. Adequate linen and personal hygiene supply are observed. Lamps/lights for each room are available to ensure the safety and com fort of all persons in the facility. Hot water temperature was measured at 114.0 degrees Fahrenheit.

The smoke detectors are located in each bedroom and common area and they are all wor king properly. The carbon monoxide detectors are located on the hallway mounted on the wall and they are all working well. (-continued in LIC 809C-)