Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Tolulope Oletubo and discussed the purpose of today’s visit.

This facility consists of (4) bedrooms, (2) bathrooms, living room, kitchen, dining room, laundry room and an attached garage. All clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center. This facility is approved for (4) 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 extinguisher is located in the laundry room and appeared to be full . 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 #3 (S-3). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file.

Client Rights-Information: Client rights are posted and were also observed in client files.

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