Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA arrived unannounced and met with Staff, Luisa Larioza. The purpose of the visit was explained. The facility is licensed for (6) developmentally disabled clients, ages 18 - 59, of which 2 may be non-ambulatory in rooms #1 and #4. There are currently 6 clients residing at the home and were placed by the San Gabriel/Pomona Regional Center.

LPA toured the facility and conducted the following domains:

Infection Control: The facility staff are wearing gloves while assisting clients. Staff are cleaning and disinfecting at least once a day.

Physical Plant & Environment Safety: The facility does not have any pool or bodies of water on the premises. There are 5 bedrooms (4 for clients and 1 for staff), 2 bathrooms, living room, kitchen, and an attached garage. Each client bedroom has the required furniture and lighting. There is a shaded area in the backyard for client use. There are no items obstructing the walkways. The smoke detectors are located in each bedroom and a carbon monoxide detector in the hallway. Knives and cleaning supplies are locked in the kitchen cabinet. Additional cleaning solutions are stored in the cabinet inside the garage.

Operational Requirements : The facility is operating within the fire clearance approval. Staff are providing care and supervision to meet the clients' needs and assisting in activities of daily living.

Food Service: There are sufficient food supplies of 2 day perishable and a week of non-perishable items observed. Foods are properly stored in the refrigerator to avoid contamination.

LPA will return to complete the remainder of the domains on a later date. An exit interview was conducted and a copy of this report was given to Staff Larioza.