Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Eugenia Souza and discussed the purpose of today's visit. Charito Lardizabal (Facility Administrator) arrived at approximately 10:55 A.M..

This home consists of (3) bedrooms, (2) bathrooms, family room, living room, kitchen dining room, office and attached garage. San Gabriel Pomona Regional Center provides case management services to all (6) clients from this home.

Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.

COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and throughout the facility.

Restrooms have hand soap, hand sanitizer, paper towels and hand washing signs posted.

Hygiene supplies observed. Additional supplies stored inside the garage.

Incontinence supplies observed. Additional supplies stored inside the garage.

Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed. Additional food supply including water supply are stored inside the garage.

Medication reviewed for (3) Clients (C-1 through C-3).

Per Administrator, all clients have the COVID-19 vaccine and first booster.

Per Administrator, all staff have the COVID-19 vaccine and first booster.

Clients were be socially distanced according to local public health guidelines.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Charito Lardizabal