Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Nicole Lian 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 clients residing at this facility.

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: Carbon monoxide detector was tested and operable. The Smoke alarms were tested and operable. The fire extinguisher was observed in the kitchen and was last serviced on 01/15/25. Hot water temperature measured between 111.2* and 112.1*. 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.

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

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