Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection on 5/2/25. LPA arrived unannounced and met with Staff, Tita Baluyut. The purpose of the visit was explained. The administrator, Jocelyn Tubianosa, arrived shortly after. 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 inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.

The facility has 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 and no pools. 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. The hot water temperature is measured within the range of 105-120 degrees F. Ther e are sufficient food supplies of 2 day perishable and a week of non-perishable items observed. Facility provides internet access and clients have devices to use. There are no clients with a restricted health condition or using postural supports at this time. LPA reviewed 6 client files and all documents are in the file. The P&I ledger was reviewed as well. LPA reviewed 3 Staff and they have the required documents in their files. Medications are centrally locked and they are being administered as prescribed. Facility has the updated emergency disaster plan and conducting quarterly drills.

LPA issued a civil penalty today due to client being left at the home unsupervised during arrival. Staff returned home immediately after being called by the administrator and stated they went to purchase items from the store. An exit interview was held and a copy of this report was given to the administrator.