Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the annual inspection. LPA arrived and met with Staff, Virginia Hernandez, who allowed entry. Administrator, Paul TAbachnikov arrived right after to assist with the visit.

LPA conducted the following domains during the visit today:

Operational Requirements: The facility is licensed for (4) ambulatory adults ages 18 - 59. There are currently 3 clients residing at the home and receive services through the San Gabriel/Pomona Regional Center.

Staffing : There is sufficient staffing at the facility, with (2) staff in the morning and afternoon shifts and (1) in the overnight shift. Staff are fingerprint cleared and associated to the facility.

Personnel Records-Training : Staff files are maintained at the facility. Administrator (Paul Tabachnikov) certificate expires on 06/05/23. Staff have current CPR/first aid training and sufficient on-going training that meets the annual requirement. LPA reviewed (4) personnel files and they all have required documentation.

Resident Records-Incident Reports: Resident files are maintained at the facility. LPA reviewed all (3) client files and they have the required documentation including current Individual Program Plan. There are no clients with a restricted health condition and are all ambulatory.

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 food 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 all 3 clients and they are being administered as prescribed by the physician.