Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an annual required visit. LPA met with staff#1, 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. 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.

This annual visit consisted of: CARE tool was used, a tour of the facility was conducted, food supply was reviewed, staff/client files were reviewed, staff/client interviews were conducted, 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 in working condition. 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 3/23/23. Carbon monoxide detectors are tested and in working condition. The first aid kit is fully stocked. Hot water temperature measured at 108.5 degrees Fahrenheit.