Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza arrived unannounced to conduct an Post Licensing inspection. The purpose of the visit was explained to DSP Erick Rascoff . The Facility is licensed for six (6) ambulaotry developmentally disabled adults ages 18-59. The facility is licensed as a level 4i home vendored by San Gabriel/Pomona Regional Center.

LPA toured and inspected the facility. It consists of four (4) bedrooms [2 private and 2 shared], three (3) bathrooms, kitchen, dining room, living room, laundry room in the garage, 2 car attached garage, and backyard patio area. Sharps were observed locked and inaccessible to residents in care. No obstructions were noted in hallways or living areas. Sufficient furniture and lighting was observed throughout the facility. There are no bodies of water.

Resident and staff file records were reviewed. Resident files contained required documentation including updated emergency information. A review of staff records indicates that all facility staff has received criminal record clearances and are associated to this facility. Staff records have current training and first aid certificates. Resident R1's file is missing the IPP, R2's file is missing a Physician's Report, and R3 is missing the IPP.

Centrally stored medications were reviewed. They were observed locked and inaccessible to residents.

Rights of Individuals with Developmental Disabilities, Evacuation Routes and facility license were all posted as required.

The report was reviewed with DSP Erick Rascoff and Isaac Oluoch. A copy of the report and appeal rights will be emailed.