Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 06/17/2023 at 1:14 pm. LPA was met by Staff #1 (S1) and explained the purpose of the visit. S1 assisted in tour of facility. Staff #2 (S2) arrived shortly after to the facility. There are three (3) level 4I developmentally disabled clients in the home. The facility is licensed for clients 18-59 years old. The facility has a fire clearance approved for four (4) ambulatory. All clients receive services from San Gabriel Pomona Regional Center. LPA requested and obtained a copy of Personnel Report, and Resident Roster.

LPA OBSERVATIONS: Tour began at 1:10 am and was led by S1. The facility is a single-story building located in a residential area with four (2) client bedrooms, two (2) bathrooms, kitchen, dining room, front yard, backyard, and attached garage.

· Front Yard: Was clean and well maintained. No hazards were observed.

· Kitchen: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA observed knives and sharps located in nearby hallway closet, to be inaccessible to 3 (three) out of 3 (three) clients in care. LPA observed several bottles of cleaning solutions and disinfectants located in the garage to be inaccessible to 3 (three) out of 3 (three) clients in care.

· Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed plenty of seating and lighting.

· Linen Closet: Contained plenty linens, towels, and hygiene products.

· Client Rooms 1 - 4: All contained the required furnishings, lighting and linens. Bedrooms were observed to be clean with plenty of closet space. All bedrooms are currently private.