Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met Administrator Cynthia Tuason and the purpose of the visit was discussed.

The following twelve (12) tool domains were completed during the visit:

1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility still encourages hand washing and self symptom check of staff and visitors. The facility has an Infection Control Plan in place. LPA collected a copy

2. Physical Plant & Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes: living room, dining area, kitchen, small staff office, four (4) clients bedrooms and two (2) bathrooms, staff break room, storage room and a detached garage. Bedroom#1 and #4 are for (2) Clients each and have required furniture. Bedroom#2 and #3 are for (1) client each and were also observed to have required furnishings. The bathrooms are clean, sanitary and in a good working condition. The hot water temperature tested in both bathrooms to be within Title 22 regulations. The passageway, walkway and patio are free of obstruction. Closet space observe for linen supply and hygiene products. The facility has night light in the hallway. The facility also has telephone services in the premises. The sharp knives/utensils as well as the toxins/cleaning supplies are stored inaccessible to clients in care. All the appliances are operational. LPA also inspected the smoke detectors and carbon monoxide detectors and they are all working well.

3. Operational Requirement: The facility is approved for serve Developmentally Disabled Adults 18-59 years old and ambulatory only. The facility is licensed as a level 4C vendored by San Gabriel Pomona Regional Center. The clearance is for (6) ambulatory clients. The last fire/disaster drill was conducted on 3/13/24.

4. Staffing: There was sufficient staffing observed in the facility during the visit. The night supervision staff also have the required training for the planned emergency procedure.