Facility Evaluation Report

Licensing Program Analyst (LPA) Wong conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools to inspect the facility. LPA met with Lead Staff Vanessa Garcia and Eduardo Zamora and explained the reason of the visit. The facility is approved for serve for four (4) Developmentally Disabled Adults, AGE RANGE 18 THROUGH 59. 4 NON-AMBULATORY. APPROVED FOR DELAYED EGRESS ON EXTERIOR GATES ONLY . The facility is licensed as a 4I home vendored by 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: Infection control Practice and Personal Hygiene Equipment (PPEs) were observed. Staff still practice hand washing, check clients and visitors temperature and mask wearing if needed. Staff also disinfected the facility every shift. The facility has an infection control plan and Covid-19 mitigation plan is in place.

2. Physical Plant and Environmental Safety: The facility is a single story house and located in residential neighborhood area. The facility include: Living room, Dining room, kitchen, recreation room, four client bedrooms, three clients bathrooms, attached garage and staff office. Each client room has one bed, one chair, one drawer, required furniture and beddings and sufficient lighting and closet space. All three client bathrooms are clean, sanitary and in a good working condition. The hot water temperature tested in all three bathrooms are tested between 113 and 115.7 degrees F which are within the Title 22 regulation. All the appliances in the kitchen and living room are working properly.