Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Angelica Simbula and discussed the purpose of today’s visit. Elizabeth Stacy arrived at approximately 11:20 A.M..

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 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 plan in place.

Operational Requirements: Staff are adhering to operational requirements.

Physical Plant & Environment Safety: Carbon monoxide detector was tested and operable (located in the hallway). The smoke alarms were tested and operable. The fire extinguisher was observed in the kitchen and appeared to be full (last service date of 03/26/25). Hot water temperature measured between 109.2* to 111.3*. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Passageways were free of obstruction.

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