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 Ana Alarcio/S-1 and explained the purpose of today's visit. Mona Dela Rosa arrived at approximately 9:30 A.M.. Per Ms. Dela Rosa, a infection control plan has been submitted to CDSS. The infection control plan was readily available at this facility.

LPA conducted a facility tour. This single-story home contains four (4) client bedrooms, two (2) bathrooms, living room, kitchen and dining area. San Gabriel Pomona Regional Center provides case management services for all (4) clients residing at this facility.

COVID-19 Infection Control Practices (including signs) were observed throughout the facility. Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.

PPE supplies observed. Additional supplies are stored inside the hallway closet.

Hygiene and incontinence supplies observed. Additional supplies are stored inside the garage.

Restrooms have hand soap, hand sanitizer and paper towels. Hand washing signs were observed posted in both bathrooms.

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

Medication reviewed for (4) Clients (Client #1 through Client #4).

Per S-1, all (4) clients are fully vaccinated including the booster vaccines.

Per S-1, all staff are fully vaccinated including the booster vaccines.

Per S-1, all (4) clients have their flu vaccine pending.

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

Staff responsible for direct care and supervision wear masks.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Ana Alarcio/S-1