Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to staff Janet Fagbohun . Administrator Kevin Piggee arrived later. There are four (4) ambulatory developmentally disabled adults ages 18-59. The facility is licensed as a level 4i home vendored by San Gabriel/Pomona Regional Center.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility encourages hand washing and self symptom check of staff and visitors. COVID-19 off site isolation plan is in place.The facility has an Infection Control Plan and COVID-19 mitigation plan.

Facility is a single story home licensed for 4 ambulatory residents. It is located in a residential area consisting of 3 client bedrooms, dining room, kitchen, living room, family room, 2 bathrooms, backyard with shaded patio furniture, and detached 2-car garage. The facility has a fire pull-alarm.

The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility has one (1) fully charged fire extinguisher. Cleaning supplies and toxic substances are inaccessible to clients.

Water temperature readings measured between the required 105 - 120 degrees Fahrenheit.