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 Elisa Apo and explained the reason of the visit. Shortly after, the administrator Alvin Capanzana arrived and assisted with the facility visit. The facility is approved for serve Developmentally Disabled Adults, age 18 through 59, 6 ambulatory, of which 2 may be non-ambulatory. The facility is licensed as a Level 4C 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, still checking client temperature twice a day and staff disinfected the facility every shift. The facility has an Infection Control Plan and COVID-19 mitigation plan in place.

2. Physical Plant-Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes living room, kitchen, dining area, five clients bedrooms and two clients bathrooms, staff office and an attached garage. Bedroom#1 - #4 has one bed, one chair, one night stand, one drawer, required furniture and beddings and sufficient lighting and closet space. Bedroom#5 has two beds, two chairs, two night stands, two drawers, required furniture and beddings and sufficient lighting and closet space. The two clients bathrooms are clean, sanitary and in a good working condition. The hot water temperature in two clients' bathrooms were tested between 111.7 and 113 degrees F which are within the Title 22 regulation