Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA met with Quadri Adisa, DSP II and explained the purpose of the visit. Administrator, Jason Piggee was called on the phone and arrived at 11:20 am to assist LPA. The facility is licensed to care for Developmentally Disabled Adults, ages 18 through 59, (4) non ambulatory, approved for delayed egress. All clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Staff are adhering to infection control requirements. Administrator reviews/updates the Infection Control plan annually.

Physical Plant/Environment Safet y: The facility is a single story home located in a residential neighborhood, contains a total of (5) bedrooms, of which (4) are client bedrooms and (1) office, (3) full bathrooms, a living room with covered fireplace, dining room with covered fireplace, family room, kitchen, computer area, backyard, and detached garage. Currently, there are (4) clients living in the facility. The interior and exterior physical plant was inspected. Client bedrooms were toured. Each bedroom contained the required bed with bedding, mattress cover/sheets, blankets, bedspread, furniture, lighting and sufficient storage space. Bathrooms have non-skid materials and contained hygiene supplies including liquid soap and toilet paper. Exit doors are free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and area provides a shade with outdoor furniture. Kitchen knives, sharps objects, cleaning supplies and toxic su bstances are locked and inaccessible to clients. LPA observed (3) fire extinguishers which were last serviced on 12/05/2025. One of the fire extinguishers was observed to be on the floor and need to be mounted on the wall. Smoke detectors were observed to be hard wired and interconnected and functioning properly. There are surveillance camera without audio in the common areas. Water temperature readings were tested in all bathrooms and measured within the required 105 - 120 degrees Fahrenheit. Fire/disaster drills are conducted monthly on each shift. Last drill was conducted on 11/15/2025.

Operational Requirements: All clients in the facility are ambulatory. Surety Bond is valid, expiring on 08/15/2027 and insured in the amount of $3000. Backyard has a covered patio and equipped with chairs for clients to utilize during outdoor activity. *****REPORT CONTINUED ON LIC809-C*****