Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met DSP Crystal Coronado and explained the reason of the visit and assisted with the visit. Shortly after, the administrator Tomasa Coronado arrived and assisted with the visit. The facility is approved for serve Developmentally Disabled Adults AGE RANGE 18 THROUGH 59. 2 Ambulatory and 2 Non-ambulatory. The facility is licensed as a level 4I 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, mask wearing for staff and self symptom check of staff. The facility has an Infection Control Plan and COVID-19 mitigation plan in place.

2. Physical Plant and Environmental: The facility is a single story house and located in a residential neighborhood area. The facility includes: living room, dining area, kitchen, closing patio, three clients bedrooms, two clients bathrooms and attached garage. Bedroom#1 and #3 has one bed, one chair, one night stand, one drawer, required furniture and bedding, sufficient lighting and closet space. Bedroom#2 has two beds, one night stand, two drawers, required beddings and furniture and sufficient lighting and closet space. The two clients bathrooms are clean, sanitary and in a good working condition. The hot water temperature tested in two clients bathrooms are between 110.3 and 113.5 degrees F which is within Title 22 regulation. All the appliances in the kitchen and living room are working probably. All the sharp knives and utensils are stored and locked under the sink.