Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA arrived met with staff, Lorenzo Tii, and informed the reason for the visit. The facility is licensed for (6) developmentally disabled adults, ages 18 - 59, of which (2) may be non-ambulatory. The facility is vendorized by the San Gabriel/Pomona Regional Center.

The facility consists of 4 bedrooms, 2 bathrooms, living room, dining room, kitchen, and an attached garage. The bedrooms have the appropriate furniture and storage space. There are extra linens and hygiene supplies. Facility has a smoke detector in each room and a carbon monoxide detector located in the hallway. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature was measured between the required range of 105-120 degrees F. Staff are providing care and supervision to meet the clients' needs. Staff are continuing to follow their infection control plan and procedures while handling clients. Sufficient food supplies of 2 day perishable and a week of non-perishable items are observed.

LPA reviewed (3) personnel records. Administrator's (Carrie Dobrenen) certificate expires on 8/31/27. Staff are receiving on-going training and have current CPR & First Aid certificates. Staff do not use any manual restraints on clients. LPA reviewed 4 client files and they have the required documents. Medications are centrally locked and inaccessible to clients. Medications are being administered as prescribed. The facility has the updated emergency and disaster plan. LPA provided a technical advisory for the drills.

No deficiencies were issued today. An exit interview was held and a copy of this report was given to N. Baez.