Facility Evaluation Report

Licensing Program Analyst (LPA) Wong conducted the required annual inspection. LPA arrived unannounced and met with DSP Perry Williams who allowed the entry of the facility and explained the reason of the visit and shortly after Administrator Omar Sapalaran Arrived and assisted with the visit. The facility is licensed for four non-ambulatory age 18-59. The facility is vendorized as Level 4C home with San Gabriel Pomona Regional Center.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and here are the domains that LPA inspected:

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

2. Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes kitchen, dining area, living room, four clients bedrooms, two clients bathrooms, laundry room and a detached garage and a storage room. Each client's room has one bed, one drawer, one chair, 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 two client's bathrooms are tested between 119.4 and 120 degrees F which is within the Title 22 regulation. All the appliances in the kitchen are working properly. The sharp knives and utensils are stored in the kitchen drawer next to the stove. All the cleaning supplies and chemicals are stored and locked in the garage. The facility has a telephone on the premises. The hallway night will be on during night time so client can have access to the non-private bathrooms. The extra personal hygiene products are stored in the garage. LPA inspected the carbon monoxide detectors and smoke detectors are interconnected and they are working well.

3. Operational Requirement: The facility are licensed for 4 non-ambulatory clients age 18 through 59 and currently the facility only has one client is non-ambulatory which is within the fire clearance. The facility would allow client to attend community events if there's an opportunity or a chance. The facility has a shaded area with table and chairs in the backyard for client to utilize the outdoor activity. The last fire drill was conducted on 4/2/24