Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with John Alfred and Horace Martin and discussed the purpose of today’s visit. Lindon Johnson arrived at approximately 9:40 A.M..

This home consists of (3) bedrooms, (1) office, (2) bathrooms (one of which is located inside the office), kitchen with dining area, living room and an attached garage. This home is approved for (4) ambulatory clients. All clients residing at this facility 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 which was observed to be posted.

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. Hot water temperature measured 114.0*. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Passageways were free of obstruction.

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