Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted an unannounced annual visit at the facility using the Compliance and Regulatory Enforcement (CARE) Tool. LPA met with licensee/administrator, Floresita Lim, and explained the reason for the visit. The facility is licensed to serve (6) Developmentally Disabled adults, ages 18 to 59, of which (4) may be non-ambulatory. The home is vendorized by the San Gabriel/Pomona Regional Center as a level 3.

LPA Chan conducted a tour of the facility with staff, reviewed files and medications. The facility is a single-story home that consists of 3 Client bedrooms, 1 Staff room, 1 office, 3 bathrooms, living room, open dining and kitchen, family room, and attached garage. The spacious outdoor has a shaded patio with seating, exercise equipment, and gardening areas. There are no items obstructing the walkway nor any swimming pool or bodies of water on the premises. The client bedrooms have the required furniture, adequate storage space, and sufficient lighting. The water was measured between 105 - 120 degrees F, which is within the required range. The food supplies was observed with the required 2-day perishables and 7-day non-perishables. All toxins, cleaning supplies, and sharps/knives are locked and inaccessible to clients. Extra hygiene supplies and PPE supplies are available. The facility has submitted the infection control plan. A smoke detector is observed in each room and a carbon monoxide detector is located by the kitchen.

LPA reviewed (5) staff files and (5) client files. The files contain the required documentation. Client rights and complaint poster are placed in a prominent area. LPA also reviewed medications for all 5 clients. The medications were observed to be documented properly and given as prescribed. Facility assists Clients with medical and dental services and provide care and supervision. There is an awake staff monitoring clients in the overnight shift.

There are no deficiencies issued today. LPA provided a technical assistance on emergency disaster drills.

An exit interview was conducted and a copy of the report was provided to the licensee.