Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 8/22/24. LPA arrived

unannounced and met with DSP, Jennifer Balvaneda. The purpose for the visit was explained. The

Administrator, Efnan Scott, arrived shortly after to assist with the visit. This facility is licensed as an Adult

Residential Facility for Persons with Special Healthcare Needs (ARFPSHN) and is vendored by the San

Gabriel/Pomona Regional Center. The facility is licensed to serve (5) developmentally disabled adults, ages

18 and over, of which (5) may be bedridden. There is currently (5) non-ambulatory clients residing at the

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools to inspect the facility and observed the following: The facility is a single story home consisting of 5 private client bedrooms, staff office, 2 bathrooms, living room, t.v. room, dining space, kitchen, laundry room, and attached garage. The backyard has a shaded area. There are no pools or bodies of water and no items obstructing the walkway. The client bedrooms are equipped with mechanical lifts. The shared bathroom is clean and sanitized. The fire extinguishers are inspected annually and is fully charged. The facility checks and documents the hot water temperature and refrigerators temperature on a daily basis. Facility has backup generators and are checked weekly. Emergency/disaster drills are conducted at least every 6 months. Medications are stored in a cart and also in the locked storage space. LPA reviewed all the clients' medications and did not observe any deficiencies. LPA reviewed all 5 client files. The files consist of the face sheet, admission agreement, consent forms, medical assessment with TB results, current IPP report, and property/valuables form. LPA also reviewed the P&I ledger for 4 out of the 5 clients. LPA checked 4 personnel records. The administrator's (Efnan Scott) certificate expired on 7/25/24, however, it is verified that the renewal documents were previously submitted and is pending to be processed by the Administrator Certification Bureau. Staff have current CPR & First Aid certification.

There are no deficiencies issued today. An exit interview was held and a copy of this report was given to the