Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. LPA met with Administrator Josefina Bernal and DSP Merly Campos. The facility is licensed as level 4 Adult Residential Facility (ARF) that is licensed for 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. Facility has sufficient Personal Protective Equipment/supplies.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood. It consists of 3 client bedrooms, 1 office room, 2 bathrooms, dining room/kitchen, living room, outdoor patio, and an attached garage.The interior and exterior physical plant was inspected. Smoke and carbon monoxide detectors were tested and are operational. The facility has one (1) fire extinguisher and a fire pull alarm. Exit doors are free of any obstruction and there are no pools or large bodies of water. Water temperature measured within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies and toxic substances are inaccessible to residents.

Operational Requirements: Fire clearance is approved for four (4) ambulatory and two (2) non-ambulatory residents. Care and supervision to meet the clients needs was observed. Special equipment and supplies are used by non-ambulatory residents. The Surety Bond is current with expiration date of 4/23/2026.

Staffing: A total of 6 staff members provide care and supervision to the clients.