Facility Evaluation Report

Licensing Program Analyst (LPA) Tao, conducted an unannounced annual inspection. The facility is licensed to serve six (6) Developmentally Disabled, non-ambulatory clients, from age 18-59. Client census is six (6). The facility is vendorized through San Gabriel/Pomona Regional Center. The annual fee is paid. LPA met with Administrator and Staff, who assisted with visit. 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 conducted; food supply was reviewed; and medications were reviewed.

LPA toured the facility inside and outside. Facility is a single-story home located in a residential neighborhood consisting of four (4) client bedrooms, two (2) bathrooms, living room, family room, dining room, kitchen, laundry room, office space, and secured pool with a locked gate at the backyard.

Bathrooms are operational. 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 comfort of all persons in the facility. Carbon monoxide detectors and smoke detectors are operable. Hot water temperature measured at 113.5 degrees Fahrenheit. (-continued in LIC 809 C-)