Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with the Administrator, Kevin Van Beek, and explained the purpose of the visit. The facility is licensed for four (4) clients, ages 18 through 59, of which two (2) may be non-ambulatory in rooms #3. The facility is vendorized by the San Gabriel/Pomona Regional Center. There are three (3) clients residing at the home.

The facility consists of 3 client bedrooms, 2 bathrooms, living room, dining room, kitchen, and a detached garage. No swimming pool or items obstructing the walkways. 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. Facility has operable smoke detectors and a carbon monoxide detector in the living room.

LPA reviewed all three (3) client files and their medications. Client files are complete and none of them has a restricted health condition. Medications are centrally stored and locked in the dining area. Staff are administering the medications as prescribed. LPA reviewed 3 staff files. Administrator's certificate (Kevin Van Beek) expires on 9/18/26 and the administrator has the current HIV and TB certificates. Staff have current CPR & First Aid training and are receiving on-going training.

The 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 administrator.