Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Grace Peligman/S-1 and discussed the purpose of today’s visit. Margie Canlobo (Administrator/S-2) arrived at approximately 9:15 A.M..

This home has 4 bedrooms, 2 full bathrooms, kitchen, dining area, living room, laundry and an attached garage. All clients receive case management services provided by San Gabriel Pomona Regional Center. Fire Clearance is for (4) non-ambulatory clients. Each client has their own bedroom. (3) out of (4) clients are over the age of 59.

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

Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place.

Operational Requirements: Last Disaster Drill was conducted on 08/02/23. Staff are adhering to operational requirements.

Physical Plant & Environment Safety: Smoke alarms were tested and operable. Carbon monoxide detector was tested and is operable. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Water temperature measured at: 111.3* in kitchen and 108.5* in the hallway restrooms.

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