Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with DSP Veronica Nosike who allowed the entry of the facility and explained the reason of the visit. Shortly after, Administrator DUROMOLA, ADEBOWALE EVELYN arrived and assisted LPA with the visit. The facility is approved for serve Developmentally Disabled Adults AGE RANGE 18 THROUGH 59 and ambulatory only. The facility is vendorized as Level 4G Home with San Gabriel Pomona Regional Center.

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

1. Infection Control: The facility has an updated infection control plan in place. The facility staff continues to practice hand washing and disinfected the facility every shift and the facility has sufficient PPE supplies.

2. Physical Plant/Environmental Safety: The facility is a single story house and located in a residential neighborhood area and the facility includes: living room, family room, kitchen, dining area, three client's bedrooms and two clients' bathrooms, staff office and an attached garage. The laundry area is located in the backyard patio. Bedroom#1 has two beds, two drawers, two night stands, required furniture and beddings and sufficient lighting and closet space. Bedroom#2 and #3 has one bed, one night stand, one chair and required furniture and beddings and sufficient lighting and closet space. The two client's bathrooms are clean, sanitary and in a good working condition. The hot water temperature in both bathrooms were tested 110.6 and 116.9 degrees which are within the Title 22 regulation. All the knives and sharp utensils are stored in the file cabinet in the staff office. All the appliances in the kitchen are working properly. All the cleaning supplies and chemicals are stored and locked in the top wall cabinet in the garage. The client's extra personal hygiene products including sanitary pad are stored in the hallway cabinet and staff office. All the extra linen are stored in the hallway cabinet. The hallway light will be on at night time for client to access the non-private bathroom. The facility has a telephone on the premises. LPA inspected the carbon monoxide detectors are working well.