Facility Evaluation Report

Licensing Program Analysts (LPAs) Galarza and Myra Cota conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to LVN Cheryl Mayronne. Administrator Matthew Mailangkay arrived later. The facility is an Adult Residential Facility for Persons with Special Health Care Needs (ARFPSHN) licensed to serve to serve adults over the age of 18 with developmental disabilities who are medically fragile and require 24-hour licensed nursing supports vendored by San Gabriel/Pomona Regional Center. The facility provides transportation services and is equipped with 1 van.

Infection Control: The facility does not have a current Infection Control Plan. A technical advisory was issued.

Physical Plant/Environment Safety: The facility is a single-story home that contains five (5) bedrooms fully equipped with mechanical lifts, four (4) bathrooms of which one (1) is equipped with a mechanical lift; a living room, great room, kitchen, dining room, laundry room, backyard shaded patio area, and attached garage. The facility's last fire inspection was conducted on 11/10/2023 Hendrick Fire Protection.

The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Electrical smoke carbon monoxide detectors were tested. The facility has sprinklers and charged fire extinguishers. Water temperature readings measured between the required 105 - 120 degrees Fahrenheit. The facility maintains emergency food supply and water. The building contains central air conditioning and heating. A 1st Aid Kit & Manual consisting of thermometer, tweezers, scissors, antiseptic, bandages, and gauze were observed. Emergency Phone numbers, exit plan and programming schedules were posted. The facility has an electric generator and back-up gas generator. The electric generator was tested and is operational, but the gas generator's battery is non-operable. NOTE: Administrator and LVN in charge did not have knowledge of proper generator test procedures.

DEFICIENCIES OBSERVED: 1. Two scissors were unlocked in a kitchen drawer 2. Cleaning supplies, detergents, and toxic substances were observed unlocked/accessible to clients in the bathroom nearest to the kitchen, underneath the kitchen sink, and in the laundry room. 3. Sharp gardening tools were unlocked in the backyard patio area.