Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA was allowed entry and met with Administrator/ Licensee, Linda Williams who assisted with the visit. At 3pm, Administrator/ Licensee, Kamara Valentine joined and assisted with the visit. The facility is licensed to serve six (6) ambulatory Developmentally Disabled clients who are ages 18-59. Current client census is six (6). None of the clients has a Restricted Health Condition. Six (6) clients residing at this home receive case management services provided by San Gabriel Pomona Regional Center. Annual licensing fees are current . LPA discussed the purpose of today's 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.

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, office area, dining area, laundry room, and outdoor activity area. Back yard activity area is a shaded area with chairs.

Bathrooms are clean and operable. Adequate linen and personal hygiene supply are in stock. Smoke detectors and Carbon monoxide detector tested and operable. First aid kit is fully stocked. Hot water temperature measured at 109.5 degrees Fahrenheit. The last Fire/ Emergency Drill was conducted on Nov 4, 2021.

Sufficient supply of perishable and non-perishable foods. Medications are centrally stored, locked and the records are current.