Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tool. LPA arrived unannounced and met with Staff, Sheryl Sanchez. The purpose of the visit was explained.

LPA toured the facility and inspected the following domains:

Infection Control: Facility is continuing to follow the infection control plan to mitigate any outbreaks. Staff are performing hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting daily and more often for high touched surfaces.

Physical Plant & Environment Safety: The facility consists of 3 client bedrooms, 1 staff office, 2 bathrooms, living room, family room, dining area, kitchen, laundry area, and attached garage. All 3 bedrooms are shared and have the required furniture. Extra hygiene supplies are observed. Facility has an operable smoke detector in each room and a carbon monoxide detector. Knives and cleaning solutions are locked. There is no swimming pool on the premises. The fireplace is covered by a fence.

Operational Requirements: The facility is licensed for (6) ambulatory adults ages 18 - 59. There are currently 5 clients residing at the home and receive services through the San Gabriel/Pomona Regional Center.

Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. Freezers are maintained at a temperature of 0 degree F and the refrigerators at a maximum of 45 degrees F. Both are kept clean and foods are properly stored.

Health-Related Services: The medications are centrally stored and locked. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for 5 clients and meds are being administered as prescribed by the physician.

LPA will return another day to complete the remainder of the domains. There are no deficiencies issued today. An exit interview was held with staff S.Sanchez and a copy of this report was given.