Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA met with Crispo Langa, DSP II and explained the purpose of the visit. The administrator Peter Munzon was called on the phone and cannot come to the facility. The facility is licensed to care for (6) Developmentally Disabled Adults, ages 18 through 59, approved for (5) ambulatory and (1) non-ambulatory in master bedroom only. All clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center. LPA utilized the full Care Compliance and Regulatory Enforcement (CARE) Tools and observed the following:

Infection Control: The required cleaning and disinfection activities are performed. Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are adhering to infection control

requirements and are trained in the proper use of all required PPE.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood, contains (4) client bedrooms, (1) office/staff room, (2 1/2) bathrooms, living room, kitchen, dining area and detached garage . Currently, there are (3) clients residing in the facility. The interior and exterior physical plant was inspected. Client bedrooms were toured and e ach bedroom has (2) beds with required beddings, furniture, sufficient lighting and closet space. Exit doors are free of any obstruction and there are no pools or large bodies of water. No security window bars installed. Facility has a working telephone service. Detached garage has a laundry area, additional non perishable food supplies and cleaning/laundry supplies in a locked cabinet. Kitchen knives, sharps objects, are kept locked in the kitchen drawer. LPA observed (1) fire extinguisher mounted on the dining area wall that has not been serviced since 3/31/2021. Facility is equipped with carbon monoxide alarm installed in the hallway and interconnected smoke detectors which were tested and operable. There are no firearms or weapons stored at the facility. Hot water temperature readings were within the required 105-120 degrees Fahrenheit.

Operational Requirements: Staff provide necessary personal assistance and care based on the clients'

needs and services plan. Surety bond insurance was verified and valid. The outdoor activity area has outdoor furniture and shaded area. *****CONTINUED ON LIC809-C*****