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 consisted 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.

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 cabinet, to be inaccessible to one (1) out of four (4) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants to be inaccessible to one (1) out of size (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.

Client Rooms 1 - 4: LPA Ramirez observed all client bedrooms to contain the required linens, furnishings, and lighting. Bedroom#4 is currently unoccupied. LPA Ramirez observed an operational manual mechanical lift in bedroom#1.

Bathroom 1-2: Water temperature in two (2) client bathrooms were within 105- 120 degrees F. Bathrooms were observed to be clean and well stocked. Grab bars were observed in bathrooms.

Backyard: No large bodies of water were observed.