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 (5) clients residing at this facility.

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

Infection Control: Facility has an Infection Control and Prevention 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 located in the kitchen (last serviced on 03/06/24). 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) through Staff #5 (S-5). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis.

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