Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 02/16/2024. LPA Ramirez was met by Administrator Elizabeth Stacy and explained the purpose of the visit. The facility is approved for six (6) developmentally disabled adults, ages 18-59 and bedroom#1 is cleared for two (2) non-ambulatory clients. There are currently four (4) clients residing in the facility and are receiving case management services provided by San Gabriel/Pomona Regional Center.

LPA OBSERVATIONS: The facility is a single-story dwelling located on a residential street. The facility consists of three (3) client bedrooms, one (1) staff bedroom, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard and attached garage.

Front Yard: LPA Ramirez observed front yard to be free of hazards. Front yard was well maintained.

Kitchen: LPA Ramirez observed appliances to be in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed a fully charger fire extinguisher nearby. LPA Ramirez observed facility menu on refrigerator.