Facility Evaluation Report

Licensing Program Analysts (LPAs) Tao and Calderon conducted an unannounced annual visit. LPAs met with Administrator, Angela Nwaka who assisted with the visit. The facility is licensed to serve four (4) Developmentally Disabled Adult clients (ages 18-59), ambulatory only. Currently, there are four (4) clients in placement. The clients receive services from San Gabriel/Pomona Regional Center. LPAs discussed with administrator regarding the purpose of today's visit and the inspection.

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.

The facility is a single-story house located in a residential neighborhood. LPA toured the facilities physical plant, indoor and outdoor. Facility consists of three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, laundry room, garage and an indoor/outdoor activity area. Passageways and exits are free of obstruction. Client rooms are furnished with appropriate furniture for clients’ comfort. Bathrooms are operational and furnished with grab bars and nonskid surfaces. Common areas are observed for the ability to safely serve the needs of the clients. A shaded area with chairs is provided in the back yard. The yard is free of debris/ hazard. Kitchen appliances are clean and were operating at the time of the visit. Sufficient supply of perishable and nonperishable foods is observed. Smoke detectors and carbon monoxide detector are operable and in compliance. Fire extinguisher is purchased on 4/14/22 and are fully charged. The first aid kit is fully stocked. Hot water temperature measured at 105.7 degrees Fahrenheit which is within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies are observed. The last Fire/ Emergency Drill was conducted on 04/02/22. Medications are centrally stored, locked and the records are current. Hazardous items are locked and inaccessible to clients. Annual licensing fee is current.

Deficiencies were observed per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator, Angela Nwaka, who’s signature on this form confirm receipt of these documents. A copy of LIC 809s report and appeal rights were provided.