Facility Evaluation Report

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

This home consists of (4) bedrooms, (2) bathrooms (one of which is in between bedroom #1 and bedroom #2), kitchen, dining room, living room and attached garage. Each client has their own bedroom. Fire Clearance is for (4) ambulatory clients. All clients 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: Smoke alarms were tested and operable. Carbon monoxide detector was tested and operable (located in the hallway) (2) fire extinguishers observed in the kitchen and appeared to be full (service tags observed-did not have service date noted). Hot water temperature measured 117.2* (hallway bathroom) and 118.2* (bathroom between bedroom #1 and bedroom #2). Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Passageways were free of obstruction.

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.

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