Facility Evaluation Report

Licensing Program Analyst (LPA) Noemi Galarza made an unannounced annual inspection visit. The purpose of the visit was explained to DSP Mary Ann Veses. The facility is an Adult Residential Facility (ARF) that serves level 4b developmentally disabled residents ages 59 and under, vendored by San Gabriel/Pomona Regional Center. The facility is a single story home located in a residential neighborhood that is licensed for six (6) ambulatory only residents. The home consists of three (3) client bedrooms, 2 bathrooms, kitchen, dining room, living room, backyard & side yard with patio area, and an attached garage with laundry area. The following 12 (CARE) tool domains were utilized during the inspection.

Infection Control: The facility staff are using appropriate hand hygiene cleaning and disinfecting the home. An Infection Control Plan was reviewed. Visit screening is still in place.

Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors were tested and are operation. The facility has one (1) fully charged fire extinguisher. Hot water temperature readings measured between the required 105 - 120 degrees Fahrenheit. Storage areas for cleaning solutions/toxins, knives, and hazardous items were inaccessible to clients.

Operational Requirements: Fire clearance is approved for six (4) ambulatory only residents. Care and supervision to meet the clients needs was observed. No special equipment and supplies are used by clients. Facility manages residents P & I monies. The Surety Bond is current.

Staffing: A total of five (5) staff members provide care and supervision to the clients.