Facility Evaluation Report

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

This home consists of (3) bedrooms, (2) bathrooms, living room, kitchen, dining area and attached garage. This facility is licensed for (4) ambulatory and (2) non-ambulatory clients. San Gabriel Pomona Regional Center provides case management services for all (4) clients residing at this facility.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Facility has an Infection Control Plan in place. There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces.

Operational Requirements: Last Disaster Drill was conducted 09/10/23. Staff are adhering to operational requirements.

Physical Plant & Environment Safety: Smoke alarms and carbon monoxide detector were tested and are operable. Fire extinguisher observed in the kitchen (last serviced 07/05/2023). Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Water temperature measured as follows: 109.5* in the hallway bathroom and 106.2* in the bedroom bathroom.

Staffing : There is sufficient staffing at the facility. Administrator Certificate on file for Michelle Samonte expires on 11/24/23. 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.***