Facility Evaluation Report

Licensing Program Analyst (LPA) S. Vaid made an unannounced visit to the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) tool in facility evaluation. LPA met with Co-Administrator, Christine Caballes and explained the purpose for the visit. Licensee/Administrator was not available for tour during the time of the visit.

The license became effective 11/8/2019, currently there are no clients residing in the home. Licensee is still working with San Gabriel/Pomona Regional Center to obtain clients.

The facility is a one-story home, operating as an Adult Residential Facility, licensed to serve (4) ambulatory adults, ages 18-59, of which all may be ambulatory, only.

During today's visit, LPA conducted a tour of the physical plant with the Co-Administrator Christine Caballes. The home is located in a residential area and consists of three (3) client bedrooms, two (2) bathrooms, a living room, dining room, kitchen, den, attached garage, and shaded patio in the backyard. There is one central entry point for universal entry screening. LPA inspected all client bedrooms and were observed to have the required furniture, storage space, and lighting. All bathrooms were equipped with a toilet, shower, and wash basin. The hot water was tested and measured at 106.4-110.3, for 2 bathrooms and kitchen taps and are in compliance. The kitchen had the required appliances and were operating properly at the time of the visit. The front and backyard are well maintained. The food supplies were observed and met the Title 22 Regulation requirements. The smoke/carbon monoxide detectors are interconnected were tested and are operational at the time of this visit. Fire extinguishers were observed throughout the premises to be fully charged and had current inspections dated 12/12/ 2023. The Licensee/Administrator's file was reviewed and observed to be complete. An interview was also conducted with the Co-Administrator. Due to no clients or staff, no other files and/or medications were reviewed. Licensee/Administrator’s certification expires 11/07/2025.

Per Title 22 Regulations, there were no deficiencies observed during the visit.

An exit interview was conducted with Co-Administrator, Christine Caballes, and a copy of the report was provided.