Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Kip Dukes and discussed the purpose of today’s visit.

This single-story home consists of (3) bedrooms, (2) bathrooms, living room, kitchen, dining area and attached garage. This facility is approved for (4) ambulatory clients. All clients receive case management services provided by San Gabriel Pomona Regional Center.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Facility has an Infection Control Plan in place.

Operational Requirements: Staff are adhering to operational requirements.

Physical Plant & Environment Safety: Smoke alarms and carbon monoxide detector (located in the hallway) were tested and are operable. Fire extinguisher is located in the dining area (last serviced 05/13/24). Last fire drill was conducted on 01/17/25. Hot water supply measured at 113.5*. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients.

Staffing : There is sufficient staffing at the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility.

Personnel Records-Training : LPA reviewed staff files for Staff #1 (S-1) through Staff #5 (S-5). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file.

Client Rights-Information: Client rights are posted and were also observed in client files.

**Refer to LIC 809C for the continuation of this report.**