Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra and Christian Gutierrez conducted the required annual inspection. LPA met with Ebenezer “Ben” Aquinola and discussed the purpose of today’s visit.

This facility is licensed for (4) ambulatory clients (ages 18-59). The fire clearance is approved for (4) ambulatory clients. Each client has their own bedroom. 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: Smoke alarms and carbon monoxide detector were tested and are operable. Fire extinguisher is located in the kitchen and appears to be full. 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.

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