Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection using the Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Administrator Mellad Falatoonzadeh and informed the purpose of the visit. The facility is licensed for (4) clients, ages 18 through 59, of which (3) may be non-ambulatory. Bedrooms #2, #3, and #4 are approved for the non-ambulatory. Delayed egress is granted for the surrounding fence. The facility is vendorized by the San Gabriel/Pomona Regional Center.

The facility is a single-story home with (4) private bedrooms, 2 bathrooms, living room, dining area, den, kitchen, laundry area, and an attached garage. The outdoor area is free of obstruction and has a shaded area for clients to use. Knives and sharps are locked in the pantry area. Cleaning supplies are also locked and inaccessible to clients. The water temperature was measured within the required range of 105 - 120 degrees F. The water sprinkler system is in place and fire extinguishers have been inspected on 11/7/25. Sufficient food supplies of 2 day perishable and a week of nonperishable was observed.

There are currently (4) ambulatory clients residing at the facility. LPA observed adequate staffing to meet clients' needs and supervision. LPA reviewed (4) client files and the required documents are observed. Medications are centrally stored and being given as prescribed. One of the clients has a restricted health condition plan in place and is able to self inject the insulin.

LPA reviewed (4) personnel files. The administrator's certificate expires on 11/10/26 and the HIV & TB certificates were issued on 11/11/24. Staff have background clearance and associated to the facility. Staff have current First Aid & CPR certificates and are receiving annual training. Per the administrator, they use CPI hold as a last resort. The Emergency Disaster Plan is reviewed annually by the administrator and drills are being conducted quarterly.

No deficiencies were observed today. An exit interview was held and a copy of this report was given to the administrator.