Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA met with Tracy Gaolese, Care staff and explained the purpose of the visit. At 11:10am, Oluwagbemiro Odofin, Administrator arrived and assisted LPA. The facility is licensed to care for (4) Developmentally Disabled Adults, ages 18 through 59, ambulatory only. All clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center. LPA utilized the full Care Compliance and Regulatory Enforcement (CARE) Tools and observed the following:

Infection Control: The required cleaning and disinfection activities are performed. Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are adhering to infection control

requirements and are trained in the proper use of all required PPE.

Operational Requirements: Staff provide necessary personal assistance and care based on the clients'

needs and services plan. Surety bond insurance in the amount of $2000 is valid. The outdoor activity area in the backyard provides a shaded area and furnished for outdoor use.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood, contains (3) client bedrooms, (1) office/storage room, (2) full bathrooms, living room with covered fireplace, kitchen, dining area, backyard, and attached garage. Currently, there are (4) clients living in the facility. The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, night stand, light, chair and sufficient closet space.

Exit doors are free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and has a covered sitting area. No security window bars installed. Facility has a working telephone service. Attached garage was inspected and there are (2) extra refrigerators and (1) freezer to stock up additional food items. Kitchen knives, sharps ob jects, are kept locked in a locked cabinet in the dining area. The cleaning supplies and toxic substances are stored in the garage and inaccessible to clients. There is (1) fire extinguisher kept in the pantry area for clients' safety, last serviced on 01/10/2026. Combo smoke and carbon monoxide detectors were tested and operable. There are no firearms or weapons stored at the facility. Hot water temperature readings were within the required 105-120 degrees Fahrenheit. *****CONTINUED ON LIC809-C*****