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 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 residing at this home receive case management services provided by San Gabriel Pomona Regional Center.

LPA utilized the Compliance and Regulatory (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: The carbon monoxide detector and smoke detectors were tested and are operable. The fire extinguisher was observed near the dining table (last serviced 05/30/25). Hot water supply measured 109.2*. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Passageways were free of obstruction.

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.

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