Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Adam Nomura/S-1 and discussed the purpose of today’s visit. Tamaru Francis (Assistant Administrator) arrived at approximately at 9:20 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 (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 extinguisher is located in the living room and appeared to be full. 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.

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