Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual inspection visit. LPA met with back-up Administrator Omar Sapalaran and explained the purpose of the visit. The facility is licensed to serve four (4) developmentally disabled non-ambulatory clients, ages 18-59. Clients receive case management services provided from San Gabriel/Pomona Regional Center. Facility annual fees are current. The facility is a single-story home located in a residential neighborhood consisting of four (4) client bedrooms, two (2) bathrooms, living room, dining room, kitchen, laundry area at the backyard, garage for storage and an outdoor activity area. LPA Ramirez obtained a copy of current liability insurance, surety bond and Emergency Disaster Plan (LIC610D/9 pages).

Front Yard: LPA Ramirez observed front yard to be free of hazards.

Kitchen: LPA Ramirez observed appliances to be clean and in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located kitchen cabinets, to be inaccessible to two (2) out of three (3) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants to be inaccessible to two (2) out of three (3) clients in care.

Dining Room/Living room: Dining room was observed to contain one table with six (6) chairs. The living room was observed to contain plenty of lighting. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed one (1) client sitting in this area during inspection.

Linen Closet/Supply Closet: Observed to contain plenty linens, towels, and hygiene products.