Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with Administrator Della Higgins and explained the purpose of the visit. The facility is licensed for (4) adults ages 18-59, of which (2) may be non-ambulatory in bedroom #1. There is (1) client residing at the facility ad receiving services by the San Gabriel/Pomona Regional Center.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.

The facility has 2 shared client bedrooms, 2 Staff rooms, 2 bathrooms, living room, dining room, kitchen, enclosed patio, and detached garage. Each client bedroom has the required furniture and bedding. Extra hygiene supplies were observed. Facility has smoke and carbon monoxide combo detectors in each room. Knives, cleaning solutions, and disinfectants are locked. There is no swimming pool on the premises. The fireplace is secured by a fence. The hot water temperature was measured at 118.5 degrees F. The facility has sufficient 2-day perishable and at least a week of non-perishable food.

LPA reviewed one client file and both staff files. Client file has the required forms such as the admission agreement, Emergency and Identification form, physician's report, consent forms, current IPP, and client rights form. The P&I ledger was reviewed. The client does not have any restricted or prohibited health conditions. The Administrator's (Della Higgins) certificate expires on 06/08/2026 and her HIV & TB training certificate was issued on 4/28/23. Staff have current CPR/first aid training.

Medications are centrally stored and locked and they are given as prescribed. The facility has the Emergency Disaster Plan and are reviewed annually.

No deficiencies were observed today. An exit interview was held and a copy of this report was given to Administrator Higgins.