Facility Evaluation Report

Licensing Program Analysts (LPAs) Cynthia Chan and Elena Mallett conducted the unannounced annual inspection. LPA met with House Manager Nick Baez and the purpose of the visit was explained. The facility is licensed to serve adults age 60 and above. The fire clearance is approved for four (4) ambulatory and two (2) non-ambulatory residents. Bedroom #1 is approved for non-ambulatory. The facility is licensed as a 4C home vendored by San Gabriel Pomona Regional Center.

The following Care Compliance and Regulatory Enforcement (CARE) tools domains were inspected during the visit today.

Infection Control: The facility has the Infection Control Plan posted at the facility. Staff are continuing to follow the Infection control practices.

Physical Plant/Environment Safety: The facility is a single story house that consists of 4 resident bedrooms, 2 bathrooms, living room, open dining and kitchen, and attached garage. The bedrooms have the required furniture and lighting. There are no pools or bodies of water observed at the facility. The hot water temperature was measured within 105-120 degrees F. The facility has one (1) fully charged fire extinguisher.

LPA will return another day to continue the annual inspection. No deficiencies were observed today. An exit interview was held and a copy of this report was given to the administrator.