Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection. The facility is licensed to serve six (6) Non-Ambulatory clients, (age 18-59). LPA was allowed entry by the facility staff#1. Administrator, Christopher Sorto joined the visit telephonically. San Gabriel Pomona Regional Center provides case management service to clients residing in this home. LPA discussed the purpose of today's visit. Facility annual fee is current.

During the visit, the inspection tool, infection control domain, including interviews with staff and clients was used, a tour of the facility was conducted; food supply was reviewed; and medications were reviewed.

LPA toured the facility inside and outside. The home is located in a residential neighborhood within the city of Covina and is a single-family house which consists of a living room, attached garage/storage, dining area, kitchen, three (3) client bedrooms and two (2) bathrooms.

The kitchen was clean and had maintained the required two (2) days perishable and seven (7) days non- perishable. All burners and stove tops were in working condition.