Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA met with Clarinda Roa/Administrator and Ricardo De Guzman/Direct Support Professional I & II and explained the purpose of the visit. The facility is licensed to care for Developmentally Disabled Adults, ages 18 through 59, six (6) ambulatory, of which two (2) may be non-ambulatory. All clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted an Infection Control Plan. Facility has COVID-19 signage posted in the facility. Bathrooms have soap and paper towels. Staff are performing hand hygiene and adhering to infection control requirements.

Operational Requirements: A current Plan of Operation was reviewe d. The facility has submitted a COVID-19 Mitigation Plan but the Infection Control Plan has not been submitted. Administrator agreed to send the plan to CCLD. Liability Insurance policy through Amguard Insurance Co. in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 9/08/2023. Surety Bond Insurance (Western Surety Insurance Company) is valid and in effect . Fire clearance was approved f or six (6) ambulatory, of which two (2) may be non ambulatory . Fire a nd Disaster Drill was cond ucted 7/08/2023. Outdoor/backyard activity area provides a shaded area and furnished for outdoor use.

Physical Plant and Environmental: The facility is a single storey home located in a residential neighborhood, contains a total of four (4) client bedrooms, one (1) staff bedroom, one (1) office, two (2) full bathrooms, (1/2) bathroom, a living room, kitchen, dining area, backyard, and attached garage. Currently, there are five (5) clients living in the facility. Facility is Level 4C . T he interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smo ke detector, bed, linen, dresser, light, and sufficient closet space. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap, paper towels, and toilet paper. Exit doors are free of any obstruction and there are no pools or large bodies of water. The sliding door screen leading to the backyard was torn and needs to be replaced. Laundry area is in the attached garage. The attached garage has extra refrigerator/freezer to keep additional food supplies. Kitchen knives, sharps objects, cleaning supplies and toxic substances are locked in a cabinet located in the garage. There is one (1) fire extinguisher observed to be fully charged and was last serviced on 5/30/2023. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. There are no cameras in the facility. Water temperature readings measured at 115.3 in bathroom #1 and 116.9 in bathroom #2 and were within the required 105 - 120 degrees Fahrenheit.