Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Nicole Lian/S-1 and discussed the purpose of today’s visit.

This home consists of (6) private client bedrooms, (3) bathrooms, living room, kitchen, dining area, exercise/laundry room. This home is approved for (4) ambulatory and (2) non-ambulatory clients. San Gabriel Pomona Regional Center provides case management services for all (6) clients residing at this facility. Note: This facility has an outstanding balance (licensing fees) of $1,135.00. This information has been provided to Ms. Montes (Accountant). LPA also provided a copy of this information to Ms. Lian/S-1 during today’s visit.

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 (located in the hallways and living room) tested and operable. Fire extinguisher is located near the kitchen (last serviced 08/06/24), 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 Staff #1 (S-1) through Staff #4 (S-4). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis

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