Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted a case management visit to change the capacity from 6 to 4. LPA met with Administrator Trupti Mody. The fire inspection conducted on 10/26/22 is cleared for a capacity of (4) developmentally disabled residents, ages 60 and above, of which (3) may be non-ambulatory and (1) bedridden. The bedridden resident is approved for bedroom #1 only. The current 3 residents residing at the facility were placed by the San Gabriel/Pomona Regional Center.

LPA toured the facility and observed the following:

* There is a total of 7 bedrooms and 3 bathrooms at the facility. Per the Administrator, the residents will only be utilizing bedrooms #1, #2, and #3, which are located to the right side of the home. Bedroom #1 has a private bathroom. All 3 resident bedrooms have exit doors with auditory alarm device installed. Bedroom #4 is occupied by the live-in staff.

* Bedrooms #5, #6, and #7 located to the left side of the home will not be used as resident bedrooms. Administrator will use those as staff rooms.

* Food supplies are sufficient for 3 residents.

* There are sufficient plates and utensils for the capacity of 4.

An exit interview was held. A copy of this report was provided to the administrator.