Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with the administrator, Francine Campana, and provided the reason for the visit. The facility is licensed to serve 4 adults ages 18 through 59, of which 3 may be non-ambulatory. The home is vendorized by the San Gabriel/Pomona Regional Center.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tool and observed the following:

The single story facility consists of 4 client bedrooms, 2 bathrooms, living room, dining room, kitchen, and an attached garage. There is no swimming pool on the premises and no items obstructing the walkways. The facility has smoke and carbon monoxide combo detectors throughout the home. LPA observed sufficient food supplies of perishable and nonperishable. Knives and cleaning solutions are locked and inaccessible to clients. The hot water temperature is measured within the required range of 105-120 degrees F. Staff are continuing to clean and disinfect throughout the day.

There are 4 ambulatory clients residing at the home. LPA reviewed files for all 4 clients and the required documents are maintained in their files. Medications were also reviewed and are being given as prescribed by the physician. LPA reviewed the administrator and 2 other staff files. Administrator's certificate expires on 2/22/25. Staff have current CPR & First Aid certificates. Staff are receiving on-going training. Facility has an Emergency and Disaster Plan and conducting monthly drills. LPA advised administrator to conduct the drills for each shift.

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