Facility Evaluation Report

Licensing Program Analyst (LPA) Vaid conducted the required annual inspection. LPA met with Norma Guevara, direct staff member, and discussed the purpose of today’s visit. Joseph Ballesteros, Administrator, arrived shortly after.

This home consists of (3) bedrooms, (2) baths, kitchen, dining area, living room and attached garage. All clients receive case management services provided by San Gabriel Pomona Regional Center.

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

1.Infection Control: Facility has an Infection Control Plan in place.

2.Operational Requirements: Staff are adhering to operational requirements.

3.Physical Plant & Environment Safety: Smoke alarms and carbon monoxide detector tested and operable. Fire extinguisher is located in the kitchen and appears full. The last drill was conducted on 12/21/2025. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients.

4.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.

5.Personnel Records-Training: LPA reviewed staff files for Staff #1 (S-1) through Staff #4 (S-4). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file.