Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Omar Sapalaran, assisted administrator who assisted with the visit. The facility is licensed to serve four (4) developmentally disabled non-ambulatory clients, ages 18-59. Clients received case management services provided from San Gabriel Pomona regional center. No clients have restricted health conditions. Facility annual fees are current. LPA explained the purpose of today's visit.

During the visit, the inspection consisted of using CARE tool, conducting facility tour; reviewing food supply; reviewing staff/clients files; interviewing staff/clients, and reviewing client's medications.

The facility is a single-story home located in a residential neighborhood consisted of four (4) client bedrooms, one (1) storage room, two (2) bathrooms, living room, dining room, kitchen, laundry area at the backyard, garage for storage and an outdoor activity area. The yard has a shaded area and free of debris/ hazard. Bathrooms are clean and operable. Sufficient supply of perishable and non-perishable foods are observed. Adequate linen and personal hygiene supply are in stock. Smoke detectors and carbon monoxide devices are dual, hardwired and operable. Hot water temperature measured at 110.5 degrees Fahrenheit. Fire extinguisher is fully charged. Medications are centrally stored, locked and the records are current. Hazardous items are locked and inaccessible to clients.

No deficiencies were cited per CCR, Title 22. Exit conference was conducted with assisted administrator. LIC 809 was provided.