Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an announced pre-licensing inspection. LPA met with Silvia Ulloa, applicant/ administrator.

Applicant is applying for Adult Residential Facility to serve clients for age range from 18 years old through 59 years old. The requested capacity is four (4), ambulatory only. Currently, there are two (2) clients residing at the facility and are at the day program or school at the time of visit. Facility receives case management services provided by San Gabriel Pomona Regional Center. This is a change of facility type. The facility is currently licensed as Grace Pineda Small Family Home, facility # 197806849. It is a small family home to serve children.

Fire clearance is granted for four (4) ambulatory clients on 05/03/24.

The property is a single-family residence located in a residential neighborhood and consist of three (3) client bedrooms, one (1) client bathroom, one (1) staff bedroom, two (2) staff bathrooms, living room, kitchen, dining room, office, and laundry area in the attached garage. Passageways, walkways and patios are free from obstructions. The entrance and side areas are free of hazards and debris. Garage is not accessible to clients. Facility had no pool or bodily of water. (- continued on LIC 809 C -)