Facility Evaluation Report

Licensing Program Analyst (LPA) Sanjay Vaid conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA Vaid met DSP workers Jenefer Tayag and Luz Flores and explained reason for visit. Administrator Margie Canlobo was notified by telephone.

The facility is licensed to serve 6 ambulatory developmentally disabled clients aged 18 to 59. Currently, there are six (6) clients in placement. Three (3) clients are over 60 years of age. All clients residing at this facility receive case management services provided by San Gabriel/Pomona Regional Center. The facility is in a residential area, and it is a single-story family home consisting of the living room, family room, kitchen, 4 client bedrooms, two shared bedroom and two private bedrooms, 2 bathrooms, laundry area, front yard, backyard, and attached garage.

LPA toured the facility and observed the following:

Each client bedroom has the required furniture and bedding. There is extra clean linen and towels in hallway closet. Smoke detectors were observed in each room and in common areas, all smoke detectors are interconnected and are operating. There is 1 carbon monoxide in the hallway, and it is properly operating. The facility has one (1) fully charged fire extinguisher kept in kitchen and is fully charged on 02/04/2025. Cleaning supplies and toxic substances are inaccessible locked in cupboards in kitchen. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction.

Four (4) staff files were reviewed and included Criminal clearance record, CPR/training, and health screening with TB. Six (6) client files were reviewed and included physicians report, TB clearance, and individual program plan (IPP)report. Last fire/earthquake drill was conducted on December 12, 2025. Infectious control plan was reviewed. Two (2) staff and one (1) client were interviewed. Six (6) client medications were reviewed. Medications are centrally stored and locked MAR log is used.

No deficiencies found on today’s visit. Exit interview and a copy of this report, provided to Staff Jenifer Tayay.