Facility Evaluation Report

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

This home is a single-story home consisting of (3) bedrooms, (1) office, (1) staff room, (2) bathrooms, living room, kitchen, dining area, family room, and an attached garage. This home is approved for (4) non-ambulatory and (2) ambulatory clients. All clients residing at this home 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.

Operational Requirements: Staff are adhering to operational requirements.

Physical Plant & Environment Safety: The carbon monoxide detector (located in the living room) and smoke detectors were tested and are operable . The fire extinguisher was observed near the kitchen and appeared to be full. Hot water supply measured 116.3” in bathroom located in the back and 116.9* in the bathroom located inside room #3. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Passageways were free of obstruction.

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