Facility Evaluation Report, 10/03/2023 — Moreno Family Home, Hacienda Heights CA

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 10/03/2023. LPA Ramirez was met by Staff#1 (S1) and explained the purpose of the visit. The facility is licensed serve six (6) developmentally disabled clients 18-59 years old. LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), and Client Roster (LIC 9020). All clients in the home receive services from San Gabriel/Pomona Regional Center.

LPA OBSERVATIONS: Tour began at 08:25 am and was led by S1. The facility is a single-story building located in a residential area with three (3) client bedrooms, one (1) staff bedroom, two (2) bathrooms, kitchen, dining room, living room, attached garage, front yard, and backyard.

Front Yard: LPA Ramirez observed one (1) wheelchair and several black and yellow large plastic storage bins in front of garage door.

Kitchen: LPA Ramirez observed appliances to be 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 in kitchen cabinet, to be inaccessible to five (5) out of five (5) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in garage area, to be inaccessible to five (5) out of five (5) clients in care. LPA Ramirez observed a fully charger fire extinguisher nearby. The kitchen sink water temperature was measured at 120.1 degrees F.

Dining Room/Living room: Dining room was observed to contain one table with plenty of seating. Living room was observed with plenty of lighting. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed signage promoting cough and handwashing etiquette in this area. LPA Ramirez observed nearby thermostat to read 71 degrees F. LPA Ramirez observed several boxes containing various items were observed stacked in various locations of the living room and dining room area. LPA Ramirez observed this area to be cluttered. LPA Ramirez will issue Type B deficiency.

Linen Closet/Supply Closet/Laundry room: Contained plenty linens, towels, and hygiene products.