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 Blanca Nuno and explained the reason of the visit. The facility is approved for serve Developmentally Disabled Adults, cleared for 6 non-ambulatory. The facility is licensed as a 4I 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. 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 area, kitchen, three clients bedrooms, two clients bathrooms and a detached garage. Each client bedroom has two beds, two drawers, night stand, chairs, required bed linen and sufficient lighting and closet space. The clients' bathrooms are clean, sanitary and in a workable condition. The hot water temperature tested in two bathrooms were 108.1 and 108.3 degrees F which are within Title 22 regulation. The appliances in the kitchen, living room and dining area are working probably. All the sharp knives and utensils are locked in the kitchen drawer. All the cleaning supplies and chemicals are locked under the sink. LPA inspected the smoke detectors and carbon monoxide detectors and they are interconnected and they are working probably. The facility has a land line telephone system for client to use it. The hallway night would turn on when it's at night, so clients can have access to the bathroom. (See LIC 809C for continuation)