Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Hanako Beltran/S-1 and discussed the purpose of today’s visit. Agnes Aguila/Administrator arrived at approximately at 1:05 P.M..

This home consists of (4) bedrooms, (2) full-bathrooms, kitchen, dining area, living room, laundry room, office and an attached garage. This home has fire clearance for (2) non-ambulatory and (2) ambulatory clients. Each client has their own bedroom. 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 extinguishers are located in the kitchen and hallway and appeared to be full (last service date: 04/02/24). Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients.

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.

Personnel Records-Training : LPA reviewed staff files for Staff #1 (S-1) through Staff #5 (S-5). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file.

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