Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced required visit. The purpose of the visit was explained telephonically to Administrator Vivian Ortiz. DSP Aldrin Demerin assisted with the visit. The facility is licensed as a level 3 Adult Residential Facility (ARF) serving developmentally disabled residents 18-59 years vendored by San Gabriel/Pomona Regional Center. Administrator certificate expires 5/18/2028.

Infection Control: The facility has an Infection Control Plan that is reviewed annually.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood. There are 4 resident bedrooms, 1 live-in staff room, 2 bathrooms, kitchen, dining room, living room, laundry area in attached garage, and outdoor shaded patio area. All client bedrooms had the required furniture for comfort and safety and had sufficient lighting. Outdoor passages were free of obstruction. Bathrooms are clean, toilets and water faucets worked properly. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Client bath towels, toiletries and personal hygiene supplies were adequately available. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in locked cabinets. Smoke detectors and carbon monoxide detectors are operable and in compliance. The facility has a 1st Aid Kit and manual. There is one fire extinguisher and a fire pull alarm. Exit doors are free of any obstruction and there are no pools or large bodies of water.

Operational Requirements: Fire clearance is approved for 4 non- ambulatory residents. Care and supervision to meet the clients needs was observed. The Surety Bond expired. A citation was issued.

Staffing: A total of 5 staff members provide care and supervision to the clients.