Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced visit for an Annual Inspection. Upon arrival, LPA met with Luisa Perez (Caregiver) and Roger Escorcia (Assistant Administrator) who later assisted with the visit. The purpose of the visit was explained upon arrival. The facility is licensed to serve 4 Ambulatory Developmentally Disabled Adult Adults, ages 18-59 years old.

The facility is located in a residential area in West Covina, Ca. There are 3 bedrooms (2 individual rooms, 1 shared room), 2 bathrooms, living room, dining room, kitchen, laundry area, office (in den), back yard with shaded patio, and an detached garage.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility staff are using appropriate hand hygiene while assisting clients’ medications. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan.

Physical Plant & Environment Safety: There are 3 bedrooms, 2 bathrooms, kitchen, laundry area, dining room, office area, detached garage and outside patio. All client bedrooms had the required furniture for comfort and safety and had sufficient lighting. All outdoor passages were free of obstruction. Bathrooms were clean, toilets and water faucets worked properly. Water temperature was measured throughout the client bathrooms and temperatures ranged from 129.8 – 133.8 degrees F, upon arrival. Client bath towels, toiletries and personal hygiene supplies were adequately available. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in a locked supply cabinet. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed to be fully charged.