Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was met by Maria Ramos, Direct Support Professional I & II (DSP I & II) and Alejandra Ramirez, Direct Care Staff and explained the purpose of the visit. Administrator Genny Guadalquivir arrived at 10:25am and assisted LPA with the inspection. The facility is licensed to care for (4) Developmentally Disabled Adults, (3) ambulatory, and (1) non ambulatory, ages 18 through 59. All clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center. The facility is a level 4I . 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 maintained. The staff stated that they use disposable gloves to clean and disinfect the high touched surfaces in the common areas. The facility has submitted a COVID-19 Mitigation Plan and the Infection Control Plan. Bathrooms have hand soap, paper towels, toilet paper. Staff are adhering to infection control requirements.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood, contains a total of (4) client bedrooms, (2) bathrooms, a living room, kitchen, dining area, backyard with shaded area, and detached garage. Currently, there are four (4) clients living in the facility. The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficient closet space. LPA observed construction work being done in one of the bedrooms and one of the bathrooms. Only (1) bathroom is working in the home. LPA observed that the dining room is being used as a bedroom for one of the clients due to the renovation work in the bedroom. Ad ministrator stated that an incident report will be submitted today regarding the construction/renovation work. Bathroom has non-skid materials and contained hygiene supplies including liquid soap, and toilet paper. There is a fire place in the living room that is covered and inaccessible to clients. Exit doors are free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and has a shaded area. Laundry area is outside next to the detached garage. There is one (1) fire extinguisher mounted on the wall in the hallway which was serviced on 02/01/2024. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. Reading was 116.7 deg F in bathroom #1.

Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. A fire clearance is in place. Surety Bond in the amount of $3000 is in effect and expires on 01/01/2025. Fire and Emergency Preparedness Drill is being conducted on a monthly basis and last drill was conducted on 04/23/2024. *****REPORT CONTINUED ON LIC809-C*****