Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 05/13/2025. LPA Ramirez was met by Direct Support Staff Sidie Koromah and explained the purpose of the visit. The facility is licensed to serve six (6) ambulatory Developmentally Disabled clients who are ages 18-59. All clients residing at this home receive case management services provided by San Gabriel/Pomona Regional Center.

LPA OBSERVATIONS: The facility is a single-story dwelling located in a residential area with three (3) client bedrooms, two (2) bathrooms, kitchen, dining room, living room, attached garage, front yard, and backyard.

Front Yard: LPA Ramirez observed front yard to be free of hazards. Front yard was well maintained.

Kitchen: LPA Ramirez observed appliances to be in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed a fully charger fire extinguisher nearby.

Dining Room/Living room: Dining room was observed to contain one table with five (5) chairs. Living room was observed to contain plenty of lighting. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed signage promoting cough and hand washing etiquette in this area.

Linen Closet/Supply Closet: Observed to contain plenty linens, towels, and hygiene products.

Client Rooms 1 - 3: LPA Ramirez observed all client bedrooms to contain the required linens, furnishings, and lighting. All client bedrooms are shared.

Due to time constraints, LPA Ramirez will return to complete annual inspection.

No deficiencies were observed at this time. Exit interview conducted. A copy of this report was provided.