Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 12/11/2023. LPA Ramirez was met by Staff Robyn Williams and explained the purpose of the visit. The facility is licensed serve four (4) ambulatory developmentally disabled clients 18-59 years old. LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), and Client Roster (LIC 9020). All clients in the facility receive services from San Gabriel/Pomona Regional Center.

LPA OBSERVATIONS: Tour began at 8:37 am. The facility is a single-story dwelling located in a residential area with four (4) client bedrooms, one (1) staff office, three (3) bathrooms, kitchen, dining room, living room, front yard, and backyard.

Front Yard: LPA Ramirez observed front yard to be free of hazards. Front yard was well maintained.

Kitchen: LPA Ramirez observed appliances to be in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed a fully charger fire extinguisher nearby. Kitchen sink temperature was measured at 112.8 degree F. LPA Ramirez observed several dead brownish insects in upper/lower cabinets near sink. LPA Ramirez observed several large brown insects crawling in pantry.

Dining Room/Living room: Dining room was observed to contain one table with four (4) chairs. Living room was observed to contain plenty of lighting. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed signage promoting cough and handwashing etiquette in this area. LPA Ramirez observed nearby thermostat to read 79 degrees F.

Linen Closet/Supply Closet: Observed to contain plenty linens, towels, and hygiene products.

Client Rooms 1 - 4: LPA Ramirez observed client bedrooms#2-4 to contain the required linens, furnishings, and lighting. Client bedroom#1 ceiling light was not operable. Several blinds in client bedroom#1 window were missing. All client bedrooms are private. Client bedroom#2 was accessible and observed unoccupied. LPA Ramirez observed three (3) cans of paint in client bedroom#2 in closet and was made accessible to three (3) out of three (3) clients in care.