Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility using the CARE inspection tool. Upon arrival, LPA met with Staff#2 (S2). The Administrator Segundino Gotladera joined the visit shortly after. The reason for the visit was explained to them.

The facility is licensed to serve six (6) ambulatory, Developmentally Disabled Adults ages 18-59. Facility currently has five (5) clients serviced by Frank Lanterman Regional Center and one (1) client serviced by San Gabriel Pomona Regional Center. Annual fees are current. The facility is a single-story home located in a residential area in Pasadena. The facility consisted of a living area, dining room, kitchen, four (4) client bedrooms, one (1) staff bedroom, two (2) client bathrooms, and one (1) staff bathroom, an office, laundry room, storage room, detached garage, front yard and back yard.

The following CARE tool domains were re viewed during this visit:

Infection Control: Sufficient PPE supplies and an Infection Control Plan maintained at the facility were observed and in compliance.

Physical Plant & Environment Safety: Physical plant tour was conducted. Clients’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. The backyard, outdoor and passageways were free of obstruction and debris/hazards. Hygiene products were readily available for clients. All storage areas for cleaning solutions, toxins, knives, and hazardous items were kept in a locked cabinet and were inaccessible to clients. (-Continued on the LIC809-C)