Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Ruth Kituku/S-1 and discussed the purpose of today’s visit. Michael White/Administrator arrived at approximately at 9:50 A.M. and assisted with this visit.

This is a two-story home. The first floor consists of a living room, office, dining room, kitchen, (1) bathroom and laundry room. The second floor consists of (3) bedrooms and (1) bathroom. San Gabriel Pomona Regional Center provides case management services for all clients residing at this home.

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

Infection Control: Facility has an Infection Control and Prevention 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 located in the kitchen, laundry room and upstairs hallway (last serviced on 01/05/24). 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 Administrator and Staff #1 (S-1) through Staff #3 (S-3). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis

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