Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. LPA was met by Alicia Canlas Federspiel , House Manager and explained the purpose of today's visit. The facility is licensed to serve developmentally disabled adults ages 18-59 years, (4) ambulatory, (1) of which may be non ambulatory. The home is vendorized through the San Gabriel Pomona Regional Center. Currently there are (3) ambulatory clients, of which none have a restricted health care condition. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Staff are adhering to infection control requirements. The facility has submitted the Infection Control Plan. The facility is a single story home consists of kitchen, dining room, living room, (4) client bedrooms, (2) bathrooms, li ving room with fireplace, dining room with fireplace, kitchen, backyard with covered patio and attached garage. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficient closet space. Smoke alarms and carbon monoxide were tested and operable. Laundry area is in the attached garage. Knives, cleaning solutions, and disinfectants are locked and inaccessible to clients. There are no firearms or weapons stored at the facility. Hot water temperature was measured at 105.2 deg F in bathroom #1, which is within the Title 22 regulations . Exit doors are free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and it has a shaded area and sitting area. A fire clearance is in place. Surety bond is valid with a bond amount of $1000 and expires on 04/01/2026. Disaster drills are conducted monthly, the last one being 08/03/2025.

A total of (15) staff members including the Licensee and Administrator provide care and supervision to the clients. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Administrator's certificate is valid and expires on 01/08/2027. Administrator has valid HIV/AIDS Training certificate. The licensee employs staff as necessary to ensure provision of care and supervision to meet client's needs.

*****Refer to LIC 809C for the continuation of this report. *****