Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Horace Martin and discussed the purpose of today’s visit. Olayinka King arrived at approximately at 11:25 A.M..

This home consists of (3) bedrooms, (2) bathrooms (one bathroom is located inside bedroom #3), living room, family/television room, kitchen, dining area and attached garage. Fire Clearance is for (6) ambulatory clients. All clients 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 were tested and operable. Carbon monoxide detector was tested and operable (located in the dining area/kitchen. The fire extinguisher observed in the kitchen and appeared to be full. Hot water temperature measured 115.6* (hallway bathroom) and 116.3* (bathroom inside bedroom #3). Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Passageways were free of obstruction.

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