Facility Evaluation Report

Licensing Program Analysts (LPAs) Elizabeth Irra and Blanca Gonzalez conducted the required annual inspection. LPA was allowed entry to the home by Elizabeth Stacy. LPA discussed the purpose of today’s visit.

This is a single-story home which consists of (3) bedrooms, (2) bathrooms, living room, kitchen, dining area, laundry room (inside the garage) and attached garage. All Clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center. This facility is approved for (4) ambulatory and (2) non-ambulatory clients (bedroom #1).

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.

Operational Requirements: Staff are adhering to operational requirements.

Physical Plant & Environment Safety: Smoke alarms and carbon monoxide detector tested and operable. Fire extinguisher was last serviced 03/06/24 (located in the kitchen). Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Hygiene supplies observed.

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 LIC 809C for the continuation of this report.