Facility Evaluation Report

Licensing Program Analysts (LPAs) Kimberly Ramirez conducted an unannounced Annual Inspection visit on 05/11/2024. LPA Ramirez were met by Caregiver Yolanda Valdez and explained the purpose of the visit. This facility is licensed as an Adult Residential Facility and is serviced by San Gabriel/Pomona Regional Center. The facility is licensed to serve SIX (6) developmentally disabled clients ages 18 and above; of which all must be ambulatory. During today’s visit, LPA Ramirez observed one (1) caregiver providing direct care and supervision to clients in care. LPA Ramirez requested and obtained copies of Personnel Report, and Client Roster

LPA OBSERVATIONS: The facility is a single-story home that contains three (3) bedrooms, two (2) client bathrooms, living room, kitchen, dining room, laundry room, backyard, shaded patio area, and enclosed activity area.

Front Yard: LPA Ramirez observed front yard to be free of hazards. LPA Ramirez observed front patio screens to be torn and contain holes. LPA Ramirez will issued Type B deficiency.

Kitchen: LPA Ramirez observed appliances to be clean and in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located kitchen cabinet, to be inaccessible to one (3) out of six (6) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants to be inaccessible to three (3) out of six (6) clients in care. Signs promoting hand washing were observed in this area. No hot water was observed to be running from kitchen faucet. LPA Ramirez will issue Type B deficiency.

Dining Room/Living room: Dining room was observed to contain one table with several chairs. The living room was observed to contain plenty of lighting. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed nearby thermostat to read 70 degrees F.