Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an annual required visit. LPA met with Administrator Jollie Ramos, who assisted with a tour of the physical plant. The facility is licensed to serve four (4) Developmentally Disabled Non-Ambulatory clients, (age 18-59). Facility is approved for delayed egress and secured perimeters. Current client census is four (4) clients. All clients residing at this home receive case management services provided by San Gabriel Pomona Regional Center. Annual licensing fees are current . LPA explained the reason for the visit.

During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed. Facility has submitted a mitigation plan and was approved.

The facility is a single house located in a residential neighborhood. The facility consisted of four (4) bedrooms, two (2) bathrooms, living room, dining room, kitchen conference/meeting room, laundry room, office area, storage closets, garage and an indoor/outdoor activity area. A shaded area with chairs is provided in the back yard. The yard is free of debris/ hazard, and there are covered trash cans. Bathrooms are clean and operational. Sufficient supply of perishable and non-perishable foods are observed. Adequate linen and personal hygiene supply are observed. Smoke detectors are monitored by a fire protection company and its last service was on 8/9/21. Carbon monoxide detectors are tested and operable. The first aid kit is fully stocked. Hot water temperature measured at 110.5 degrees Fahrenheit. The last fire/ emergency drill is conducted on 5/5/22. Delayed egress/ exits are tested and operable. (-continued in LIC 809C-)