Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. Upon arrival, LPA met with Administrator, Margie Canlobo, who assisted with visit. The facility is to serve (3) non-ambulatory and (1) ambulatory Developmentally Disabled individuals, age 18 through 59 years old. Annual fees are current. LPA discussed with administrator regarding the purpose of today's visit and the inspection.

All current clients were placed by San Gabriel/Pomona Regional Center. Administrator certificate is current, expires on 12/22/22. Annual fees are current.

During the visit, the following domain of the new inspection tool was used: infection control domain; a tour of the facility was conducted; food supply was reviewed; and medications were reviewed.

This is a single story home which consists of four (4) bedrooms, two (2) bathrooms, kitchen with a dining area, living room, laundry room, and attached garage. Facility maintains the required two (2) days perishable and seven (7) days non- perishable. Clients’ bedrooms have beds, dresser, and closet space available. Adequate linen and personal hygiene supply are observed. Lamps/lights for each room are available to ensure the safety and comfort of all persons in the facility. Hot water temperature was measured at 107.1 degrees Fahrenheit. (-Continued in LIC 809C-)