Facility Evaluation Report

Licensing Program Analyst (LPA) Wong conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Mayra Rufino , House Manager at the facility and was granted access into the home. Administrator Glorie Pascasio arrived shortly to assist the annual inspection. The facility is vendored as Level 4I (Code 113) through the San Gabriel/Pomona Regional Center

1. Infection Control: Facility has an updated infection control plan in place. Facility staff continue to practice hand washing with clients and disinfect the high touch service area several times a day. 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, living room, dining area, staff office, activity room, medication closet, linen closet, four client's bedrooms and two client's bathrooms and an attached garage. All four client's bedrooms have one bed, one chair, one drawer, one night stand, required beddings and furniture and sufficient lighting and closet space. The two client's bathrooms are clean, sanitary and in a good working condition. The two client's bathrooms hot water temperature were tested between 116.7 and 116.9 degrees F which is within Title 22 regulation. All the sharp knives and utensils are stored and locked in the kitchen drawer. All the kitchen appliances are working properly. The chemicals and cleaning supplies are stored and locked in the cabinet in the garage. The carbon monoxide detectors and smoke detectors are interconnected and they are working well. The extra personal hygiene products are stored and locked in the medication closet. The hallway light is always on during night time for client to access the non-private bathrooms. The hallway also has a sensor light. The facility has a telephone service on the premises.

3. Operational Requirement: Facility is licensed for four non-ambulatory and currently three clients is non-ambulatory and one is ambulatory which is within the fire clearance requirement. The last fire drill was conducted on 12/7/23 and the last earthquake drill was conducted on 12/12/23. The client would be able to participate community events or activities if there's an opportunity. The facility has a shaded area with table and chairs in the backyard for client to utilize the outdoor activity.