Facility Evaluation Report

Licensing Program Analysts (LPAs) Elizabeth Irra and Blanca Gonzalez conducted the required annual inspection. LPAs were allowed entry to the home by Sophia Simbulan. LPA discussed the purpose of today’s visit. Alice Reyes joined this visit shortly after.

This is single-story home which consists of (4) bedrooms, (2) bathrooms [1 bathroom is located inside bedroom #1], living room, dining room, kitchen and detached garage. Currently, each client has their own bedroom. This facility is approved for (6) 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: Smoke alarms and carbon monoxide detector tested and operable. Fire extinguisher was last serviced 01/08/25 (located in the kitchen). Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. Hygiene supplies observed.

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**