Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met MARGIE KIMBLE, administrator, who assisted with visit. Facility is licensed to serve four (4) non-ambulatory Developmentally Disabled clients who are age 18-59. Facility is approved for delayed egress and secured perimeters. Client#3 has a Restricted Health Condition. Three (3) clients residing at this home receive case management services provided by San Gabriel Pomona Regional Center. LPA discussed the purpose of today's visit to staff.

During the visit, the infection control domain tool was used, staff and clients were interviewed, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed.

The facility is a single-family home located in a residential neighborhood and consist of three (3) client bedrooms, two (2) bathrooms, living room, kitchen, den, dining area and laundry area. Back yard activity area is a shaded area with chairs and free of debris/ hazard.

Bathrooms are clean and operable. Adequate linen and personal hygiene supply are in stock. Dual Smoke/Carbon monoxide detectors are tested and operable. First aid kit is fully stocked with manual. Hot water temperature measured at 113.8 degrees Fahrenheit. The last Fire/ Emergency Drill was conducted on 10/25/22. Delayed egress and audio device are working.

Sufficient supply of perishable and non-perishable foods are observed. Medications are centrally stored, locked and the records are current. Medication that requires refrigeration are locked and stored inside the refrigerator.

Hazardous items are locked and inaccessible to clients. Fire extinguishers is fully charged and located in the kitchen. (-continued in LIC 809 C-)