Facility Evaluation Report

Licensing Program Analysts (LPAs) Elizabeth Irra and Mayra Cota conducted the required annual inspection. LPA met with Dennely Zarazua/S-1 and discussed the purpose of today’s visit.

This home consists of (3) bedrooms, (1) bathroom, kitchen, dining area, living room and an attached garage. All clients residing at this home receive case management services provided by San Gabriel Pomona Regional Center. This home is approved for (6) 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 extinguishers appear to be full (laundry/kitchen and living room). 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) and Staff #5 (S-5). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis.