The facility is approved for (4) ambulatory only clients ages 18 to 59. All Clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center.

FACILITY TOUR AND OBSERVATIONS:

Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

Physical Plant

The facility is a one-story residential home consisting of four (4) client bedrooms, a kitchen, laundry area, dining room, living room, two (2) bathrooms (one of which is a private restroom), an attached garage with storage, and a backyard patio. The backyard patio was observed; however, shaded seating was not present. The attached garage contained an additional refrigerator and emergency supplies. All four bedrooms contained the required furniture, including a bed with a clean mattress, linens, dresser, chair, and adequate lighting. Two bedrooms were missing one piece of required furniture. Staff reported that one item was in the process of being replaced. For the second bedroom, staff indicated the client declined the additional furniture item. Extra clean linens and towels were stored in clients’ rooms/closets, and all furniture was observed to be in good condition. Both bathrooms were equipped with functioning sinks, toilets, and showers, as well as required grab bars and non-skid mats. The hot water temperature measured within the required range of 105–120°F. Smoke and carbon monoxide detectors were observed to be operational, and a fully charged fire extinguisher was available. All exits were clear of obstruction, and no bodies of water were present on the property. (Continued on 809C)

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Refrigerators and freezers were maintained at proper temperatures (refrigerators at a maximum of 40°F and freezers at 0°F) and contained a sufficient supply of at least two (2) days of perishable food and seven (7) days of non-perishable food. An additional refrigerator located in the garage contained food items. Knives were stored in a locked kitchen cabinet, and cleaning supplies were secured in a locked cabinet near the kitchen, inaccessible to clients.

Health-Related Services & Records:
Three (3) client files were reviewed and contained current required documents (Admissions Agreements, Pre-Placement Appraisals, Consents, Needs/Service Plans, Physician’s Reports with TB/ambulatory status, Rights acknowledgments, and IPPs). Medical/dental care was current. Three (3) medications were reviewed; medications are centrally stored in living room area cabinet, locked, and labeled. MAR logs were current. P&I funds were reviewed.

Disaster Preparedness:
Last fire/earthquake drill was conducted in January 5, 2026, with logs available. LIC 610D Emergency Disaster Plan was updated and provided. Emergency supplies were observed.

Personnel Records & Training:
Three (3) staff files were reviewed and included criminal record clearances, CPR/First Aid, DSP training, and TB screenings. Administrator Certificate for Jeffrey Vitangcol was valid through October 22, 2026. Staffing ratio met requirements.

An exit interview was conducted with Jeffrey Vitangcol, Administrator During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be provided via email.