Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to Facility Manager Janet Fagbohun. The facility is licensed as a level 6 Adult Residential Facility (ARF) serving developmentally disabled residents 18-59 years vendored by San Gabriel/Pomona Regional Center.

Infection Control: The Infection Control Plan includes Environmental cleaning and disinfection activities.

Physical Plant/Environment Safety: The facility is a single story home 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 extinguisher, fire pull-alarm, and a First Aid Kit & Manual. Smoke and carbon monoxide detectors were tested and are operational. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Resident rooms had required furniture, linens, and personal hygiene supplies. Bathrooms are clean and operational. Cleaning supplies, knives, and toxic substances are inaccessible to residents. Comfortable temperature for residents is maintained. Exit doors are free of any obstruction and there are no pools or large bodies of water.

Operational Requirements: Fire clearance is approved for four (4) ambulatory only residents. Care and supervision to meet the clients needs was observed. No Special equipment or supplies are used by residents. The facility handles resident monies. The Surety Bond expires 7/1/2029.

Staffing: A total of 8 staff members provide care and supervision to the clients.