Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. When LPA arrived at the facility at 9:45am, no one was there to answer the door. At 10:16am, LPA spoke with Caryn Clayton Administrator on the phone who said she would contact the co-Administrator Cameron Clayton to meet with LPA. At 10:45am, LPA met with Cameron Clayton and explained the purpose of the visit and was able to gain entry. The facility is licensed to care for six (6) Developmentally Disabled clients age 18-59, approved for ambulatory only. All clients residing at this Specialized facility receive case management services provided by San Gabriel Pomona Regional Center.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility has submitted the Infection Control Plan. Staff are adhering to infection control requirements.

Physical Plant/Environment Safety: The facility is a single storey home located in a residential neighborhood, contains a total of (3) client bedrooms, (2) bathrooms, a living room, den used as activity area and office area, kitchen, dining area, backyard with shaded area, and detached garage . Currently, there are (6) clients living in the facility. One client relocated from another home in Altadena that was damaged in the Eaton fire. The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficient clo set space. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap, and toilet paper. There is a fire place in the den that is not functioning, and LPA recommended adding a permanent cover to it. The facility phone was not working when LPA tested it and Administrator agreed to contact the phone company to get it fixed. Exit doors are free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and has a shaded area and sitting area. Laundry area is located next to the kitchen. There are (2) fire extinguishers located in the kitchen and in the den, was serviced on 09/21/2024. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. Reading was 108.3 deg. F in bathroom #1 and 108.1 deg F in bathroom #2.

Operational Requirements: The Infection Control Plan has been updated and added to the Plan of Operation. A fire clearance is in place. Last Fire/Disaster Drill was conducted on 03/16/2025 and training conducted on a quarterly basis. Surety Bond is current and insured in the amount of $2000, valid through 10/13/2027.