Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Margie Canlobo and discussed the purpose of today’s visit.

The home consists of (4) bedrooms, (2) full bathrooms, kitchen, dining area, living room, laundry area and an attached garage. Fire clearance is for (4) non-ambulatory clients. Each client has their own bedroom. 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 which was observed to be posted.

Operational Requirements: Staff are adhering to operational requirements.

Physical Plant & Environment Safety: Smoke alarms were tested and operable. Carbon monoxide/Smoke detector combination unit was tested and operable (located in the living room) . The fire extinguisher observed in the living room and appeared to be full (last serviced 02/04/25). Hot water temperature measured 105.7* (hallway bathroom) and 106.1* (bathroom near room#1). 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.***