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 with DSP Crystal Coronado and the administrator Tomasa Coronado and they both assisted LPA 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: Facility has an updated infection control plan in place. The facility staff continues to practice hand washing with clients and disinfect the facility. Observed PPE supplies and it's sufficient.

2. Physical Plant/Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes: kitchen, dining area, living room, three client's bedrooms, two client's bathrooms, patio area and an attached garage with laundry area. Bedroom#1 and #3 has one bed, one drawer, one night stand, required bedding and furniture and sufficient lighting and close space. Bedroom#2 has two beds, one nigh stand, two drawers, and required bedding and furniture and sufficient lighting and closet space. The two client's bathrooms are clean, sanitary and in a good working condition. The hot water temperature in two client's bathrooms are tested 109.4 and 117.6 degrees F which is with the Title 22 regulation. All the kitchen appliances are working properly. The sharp knives and utensils are stored and locked in the cabinet in the garage and inaccessible to clients. All the chemicals and cleaning supplies are also stored and locked in the cabinet in the garage. All the extra personal hygiene products are stored in the cabinet in the garage too. There's a night light in the hallway for client to access the non-private bathrooms. LPA inspected the carbon monoxide detector and it's mounted on the wall and near the Television in the Living room and it's working well. The facility has a telephone services in the premises.