Facility Evaluation Report

Licensing Program Analysts (LPA) Elizabeth Irra and Blanca Gonzalez conducted the required annual inspection. LPAs met with Eric Howard. LPA explained the purpose of today's visit.

This home consists of (3) bedrooms, (2) bathrooms, kitchen, dining area, den/game room, living room and attached garage. This facility is approved for (4) ambulatory clients. All clients residing at this facility 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: Smoke alarms tested and operable. Carbon monoxide detector was tested and operable. The fire extinguisher was observed in the kitchen (near the sink) and appeared to be full (last serviced: 09/26/24). Hot water supply measured between 113.3* to 114.4*. 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.

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