Facility Evaluation Report

Licensing Program Analysts (LPAs) Cynthia Chan and Mayra Cota conducted the unannounced annual inspection on 10/4/24. LPAs met with Staff, Marc Marquez, and explained the reason for the visit. The facility is licensed for (3) adults, ages 18 - 59, of which 3 may be non-ambulatory. There are currently 2 clients residing at the facility and receiving services provided by the San Gabriel/Pomona Regional Center.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools to inspect the facility.

The facility consists of 3 client bedrooms, 1 staff office, 1 small storage room, 2 bathrooms, living room, dining room, kitchen, laundry room, and garage. The spacious backyard has a shaded area with chairs and recreational supplies. Each client bedroom has the required furniture and bedding. Extra hygiene supplies and linens are observed. Knives, cleaning solutions, and disinfectants are locked and clients cannot access. Facility staff are using appropriate hand hygiene and wearing gloves when necessary.

The facility is operating within the approved fire clearance. Staff are providing the care and supervision and each client has an one-on-one staff. Sufficient food supplies of 2 day perishable and a week of non-perishable are observed. The kitchen is clean and free of pests.

There is sufficient staffing at the facility. Overnight staff are awake and monitoring clients. The Administrator's certificate expires on 10/26/2025. The administrator's HIV and TB certificate was issued on 10/25/23. LPAs reviewed 3 staff files. Staff files contain the current First Aid/CPR certificates, Health Screening and Tuberculosis results, and Personnel Record. Staff are receiving on-going training. LPA reviewed 2 Client files. The files include the Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Weight Record, Consent For Medical Treatment, Individual Program Plan/IPP, Client Rights, and Property Valuable forms. The P&I ledgers were also reviewed. Medications are centrally stored and locked in the dining area. LPAs reviewed medications for both Clients and they are being administered as prescribed. Staff utilized the Medication Administration Record (MAR) log to document when routine medications and PRNs are being given. The facility has the Emergency Disaster Plan and conducting monthly disaster drills for each shift.

No deficiencies issued today. A copy of this report is given to Staff Seymour.