Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 8/13/24. LPA arrived unannounced and met with Staff, Richard Declaro. The purpose of the visit was explained. Administrator, Mona Dela Rosa, arrived shortly after to assist. The facility is licensed to serve 4 adults ages 18 through 59, of which 4 may be non-ambulatory. The home is vendorized by the San Gabriel/Pomona Regional Center.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tool and observed the following:

The single story facility consists of 4 client bedrooms, 2 bathrooms, living room, kitchen, and a detached garage. There is a carbon monoxide detector in the living room. There are smoke detectors throughout the home are interconnected and operable. Facility has sufficient food supplies and foods are properly stored in the refrigerator. Knives and cleaning solutions are locked and inaccessible to clients. The hot water temperature is measured within the required range of 105-120 degrees F. Staff are continuing to clean and disinfect throughout the day.

There are 4 ambulatory clients residing at the home. LPA reviewed files for all 4 clients and the required documents are maintained in their files. Medications were also reviewed and are being given as prescribed by the physician. There are current no clients with any restricted or prohibited health conditions residing at the home.

LPA reviewed the administrator and 2 other staff files. Administrator's certificate expires on 2/22/26 and the HIV & TB training were taken on 6/4/23. Staff have current CPR & First Aid certificates. Staff are receiving on-going training. The administrator has the updated Emergency and Disaster Plan and conducting different types of drills with staff. LPA advised administrator to conduct the drills for each shift.

There are no deficiencies issued today. An exit interview was held and a copy of this report was given to the administrator.