Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with staff. The reason for the visit was explained. The facility is licensed for six (6) ambulatory adults, ages 18 - 59. The facility is vendorized by the San Gabriel/Pomona Regional Center.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.

The facility consists of (3) client bedrooms, (1) staff room with a bathroom, (1) communal bathroom, living room, dining area, kitchen, and a garage. The bedrooms have appropriate furniture and storage space. There are extra linens and hygiene supplies. Facility has smoke detectors in each room and a carbon monoxide detector located in the hallway. Knives and cleaning solutions are locked. The hot water temperature was measured within the required range. Sufficient food supplies of 2 day perishable and a week of non-perishable items observed. LPA reviewed records and medications for all (5) clients. The clients files have the required documents and medications are being administered as prescribed. There is one client with a restricted health care plan. Staff do not use manual restraints. LPA also reviewed 3 personnel records. Administrator (Josefina Teodoro) certificate expires on 12/15/26 and the HIV & TB certificate was issued on 8/8/25. Facility staff have current CPR & First Aid certificates. The facility is conducting quarterly drills but does not have the updated Emergency Disaster Plan.

A deficiency was issued for the Emergency Disaster Plan. An exit interview was held and a copy of this report, along with appeal rights, was given to Staff Morris.