Facility Evaluation Report

Licensing Program Analyst (LPA) Daniel Konishi conducted the unannounced Annual Inspection and met with Administrator Mercedes Corpuz who allowed the entry of the facility and explained the reason of today's visit. The facility is licensed for age range 18 through 59 and ambulatory only. The facility is vendorized as Level 4A home with San Gabriel Pomona Regional Center.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical Services, Disaster Preparedness, and Emergency Intervention.

Infection Control Plan: The facility staff continue to practice hand washing and using gloves in the facility. Staff would clean and disinfect once a day and more often for high touched surfaces area. Facility has sufficient PPE supplies and has an Infection Control Plan in place.

Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes: living room, kitchen, dining area, three clients bedrooms, one client bathroom and one live in staff room and an attached garage. Each client bedrooms have two beds, chair, two dressers, required furniture and beddings and sufficient lighting and closet space. The client's bathroom is clean, sanitary and in a good working condition. Toilets and faucets are in working condition. The hot water temperature tested in the client's bathroom was 111.2 degrees F which is within the Tittle 22 regulation. All the appliances in the kitchen are working properly. The sharp knives are locked and stored in the kitchen drawer. The cleaning supplies are stored and locked in the cabinet in the garage. The extra personal hygiene products are stored in the garage cabinet. The hallway light is always on during night for client to access the non-private bathroom. Clean linens, towels, blankets, and pillows are stored in the hallway closet.