Facility Evaluation Report

Licensing Program Analyst (LPA) Wong conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with DSP Araceli Aguilar and explained the reason of the visit. The facility is approved for serve for four (4) Developmentally Disabled Adults ages 18-59, approved for ambulatory only. The facility is licensed as a 4G home vendored by San Gabriel Pomona Regional Center.

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

1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility still encourages hand washing, checking client temperature , and staff disinfected the facility every shift and visitor screening and mask wearing. The facility has an Infection Control Plan and COVID-19 mitigation plan in place.

2.Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes: living room, dining room, kitchen, laundry room, staff bathroom, three clients bedrooms, two clients bathrooms and an attached garage/Staff Office. All three clients bedrooms have two beds, two night stands, two chairs, required furniture and beddings and sufficient lighting and closet space. The two clients bathrooms are clean, sanitary and in a good working condition. The two client's bathrooms hot water temperature were tested between 111.5 and 112.2 degrees F which are within the Tittle 22 regulation. All the appliances in the kitchen and living room are working properly. The sharp knives are stored and locked in the kitchen drawer. The cleaning supplies and chemicals are stored and locked under the sink and the locked cabinet in the laundry room.