Facility Evaluation Report

Grayburn Home, Pomona07/09/2024Licence 198601885

Capacity4
Census4
Date signed07/09/2024 01:33:50 PM
The inspector’s account

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Adrienne McNeill/S-1 and discussed the purpose of today’s visit. LaTonya King arrived at approximately at 11:40 A.M..

This is a single-home with (4) bedrooms, (2) bathroom, living room, kitchen, dining area and an attached garage. Fire Clearance is for (1) Ambulatory and (3) Non-Ambulatory. All clients from this home receive case management services provided by San Gabriel Pomona Regional Center.

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 are located in the kitchen and hallway (last serviced on 09/15/23). 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 Screening on file.

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

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction