Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with Staff Mayra Torres and explained the reason for the visit. The facility is licensed for six (6) clients, ages 18 through 59, of which three (3) may be non-ambulatory in rooms #3 and #4. The facility is vendorized by the San Gabriel/Pomona Regional Center.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools to inspect the facility.

The facility consists of 5 client bedrooms, 2.5 bathrooms, living room, dining room, kitchen, and an attached garage. No swimming pool on the premises or items obstructing the walkways. The fireplace is secured with a fence. Sufficient food supplies of two days of perishables and a week of non-perishables are observed. Knives and cleaning supplies are locked. The hot water temperature was measured within the range of 105-120 degrees F. The backyard has a covered area with a table and chairs for clients to use. Medications are centrally stored and locked in the living room area. Staff are administering the medications as prescribed. LPA reviewed 3 staff files. The administrator's (Michelle Plaza) certificate expires on 1/13/27 and the HIV and TB certificates are current. Staff have current CPR & First Aid training and are receiving on-going training. Six client files were reviewed and are complete. Emergency Disaster Plan is being reviewed annually and facility is conducting emergency drills at least quarterly for each shift.

No deficiencies were observed today. An exit interview was held and a copy of this report was given to the backup administrator.