Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 11/25/2023. LPA Ramirez was met by Direct Support Staff Vanessa Panlilio and explained the purpose of the visit. The facility is licensed serve six (6) developmentally disabled clients 18-59 years old. The facility is a level III home and may care for two (2) non-ambulatory clients. 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 11:05 am. The facility is a single story dwelling located in a residential area with three (3) client bedrooms, one (1) staff bedroom, one (1) activities room, two (2) bathrooms, kitchen, dining room, living room, attached garage, front yard, and backyard.

Front Yard: LPA Ramirez observed front yard to be free of hazards.

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 six (6) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in kitchen cabinet, to be inaccessible to five (5) out of six (6) clients in care. LPA Ramirez observed a fully charger fire extinguisher nearby. Kitchen sink temperature was measured at 124.4 degree F.

Dining Room/Living room: Dining room was observed to contain one table with six (6) chairs. Living room was observed to contain plenty of lighting. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed nearby thermostat to read 74 degrees F.

Linen Closet/Supply Closet: Observed to contain plenty linens, towels, and hygiene products.

Client Rooms 1 - 3: LPA Ramirez observed all client bedrooms to contain the required linens, furnishings, and lighting. All client bedrooms are shared.