Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. LPA was met by Tita Baluyut, DSP I and explained the purpose of the visit. The administrator Jocelyn Tubianosa Manalo was called on the phone . The facility is licensed to serve (6) developmentally disabled adult age range 18 through 59, (2) non ambulatory only in Room 1 & 4. At 11:35am, Maria Luisa Larioza, DSP II arrived to assist LPA. There are currently (6) clients residing at the home and were placed by the San Gabriel/Pomona Regional Center. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today 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.

Physical Plant & Environment Safety: This facility is a single story home consists of (4) client bedrooms, (1) staff bedroom, (2) bathrooms, living room, kitchen, dining area, attached garage and backyard. Client bedrooms were toured and have sufficient storage space and lighting. Knives, cleaning solutions and disinfectants are locked under the kitchen sink cabinet. However, a cabinet with additional cleaning supplies including bleach inside the garage was unlocked. The smoke detectors are located in each bedroom and a carbon monoxide detector in the hallway. Smoke alarm in one of the client's bedroom was inoperable, no battery when tested. No security window bars installed. Facility has working telephone service. Water temperature readings are within the required 105 - 120 degrees Fahrenheit. Indoor passageways were kept free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and has a sitting area with outdoor furniture.

Operational Requirements: Staff provide necessary personal assistance and care based on the clients' needs and services plan.(2) fire extinguishers which were placed on the floor need immediate servicing as both were missing the valid annual tags. Surety bond insurance is in place. The outdoor activity area in the backyard provides a shaded area and furnished for outdoor use. *****Refer to LIC 809C for the continuation of this report.*****