Facility Evaluation Report

Licensing Program Analysts (LPAs) Elizabeth Irra and Mayra Cota conducted the required annual inspection. LPA met with Jorge Romero/S-1 and discussed the purpose of today’s visit.

This is approved for (4) non-ambulatory clients. This home consists of (4) private client bedrooms (each client has their own private bedroom), (2) full bathrooms, living room, kitchen, dining area, laundry room and has an attached garage. San Gabriel Pomona Regional Center provides case management services for all clients residing at this home.

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 extinguishers appear to be full and were last serviced on 04/05/24 (located in the kitchen pantry, living room and garage). Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients.

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.

Personnel Records-Training : LPA reviewed staff files for Staff #1 (S-1) and Staff #3 (S-3). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis.

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