Facility Evaluation Report

Licensing Program Analyst (LP A) Galarz a conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to DSP Idefonso Hernandez. Assistant Administrator Maria Biguerias assisted with the visit. Assistant Administrator Ikenna Okoli arrived later. The facility is licensed as level 6 Adult Residential Facility (ARF) that serves developmentally disabled residents ages 59 and under vendored by San Gabriel/Pomona Regional Center.

Infection Control: The Infection Control Plan includes Environmental cleaning and disinfection activities.

Physical Plant/Environment Safety: The f a cility is a single-story home located in a residential area consisting 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. Front yard is landscaped with grass. Smoke and carbon monoxide detectors were tested and are operational. The facility has three (3) fire extinguisher and a fire pull alarm. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances are inaccessible to residents. Exit doors are free of any obstruction and there are no pools or large bodies of water. A discarded sofa was observed in the backyard patio area.

Operational Requirements: Fire clearance is approved for six (6) ambulatory only residents. Care and supervision to meet the clients needs was observed. No Special equipment or supplies are used by residents. There is a current Surety Bond.

Staffing: A total of 12 staff members provide care and supervision to the clients.