Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with the Licensee Valarie Donelson and administrator Tamaru (Nikki) Francis and allowed the entry of the visit and assisted with today's visit. The purpose for the visit was explained. The facility is licensed and APPROVED FOR 6 AMBULATORY CLIENTS, AGES 18-59 and the facility is vendored as Level 4F with San Gabriel Pomona Regional Center.

1. Infection Control: The facility has an Infection Control Plan in place and the facility continue to practice infection control with hand washing and disinfecting the facility. The facility has sufficient PPE supplies.

2. Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes: kitchen, dining area, living room, three clients bedrooms, two clients bathrooms and a detached garage. Each client's bedroom has two beds, two drawers, night stand, required furniture and beddings and sufficient lighting and close space. The client's bathrooms are clean, sanitary and in a good working condition. The hot water temperature in both bathrooms were tested between 113.7 and 116.2 degrees F which is within the Title 22 regulation. All the kitchen appliances are working properly. All the sharp knives and utensils are stored and locked in the kitchen cabinet. All the chemical and cleaning supplies are stored and locked in the cabinet near the entrance way. The extra personal hygiene are stored in the cabinet near the entrance way. There's a telephone service on the premises. The Hallway Light and automatic light will be on during night time for client to access the non-private bathrooms. LPA inspected the carbon monoxide detectors and it's working well. The passageway, walkway and patio are free of obstruction.