Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Arrion Quinn and discussed the purpose of today’s visit. Valerie Donelson (Administrator) arrived at approximately 10:10 A.M..

This home consists of 3 bedrooms, 2 baths, kitchen, dining area, living room and attached garage. There are (4) clients residing at this home. All clients receive case management services provided by San Gabriel Pomona Regional Center. Fire Clearance is for (4) ambulatory clients.

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

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

Operational Requirements: Last Disaster Drill was conducted on 05/26/23. Staff are adhering to operational requirements.

Physical Plant & Environment Safety: Smoke alarms were tested and operable. Fire extinguisher is located near the dining table and was last serviced on 09/15/22. Carbon monoxide detector is located in the kitchen (tested and operable). Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Water temperature measured at: 110.0*.

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