Facility Evaluation Report

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Required-1 year visit and met with DSP/House Manager, Tina Hardy and LPA explained the purpose of the visit. Administrator, Cameron Clayton arrived shortly after and helped assist with the visit. 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 an Infection Control Plan in place. Staff are adhering to infection control requirements.

Physical Plant/Environment Safety: The facility is a single-story home located in a residential neighborhood, contains a total of three (3) client bedrooms, two (2) bathrooms, a living room, den used as activity area and office area, kitchen, dining area, backyard with shaded area, and detached garage. 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 closet space. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap, and toilet paper. Extra liens and towels are stored in the hallway closet. There is a fireplace in the den that is not functioning and is inaccessible to clients. 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 two (2) fire extinguishers located in the kitchen and in the den, which was last inspected on 8/22/2025. Smoke alarms and carbon monoxide were tested and operable. [Continue to LIC809-C]