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 Facility Administrator and explained the purpose of today's visit. LPA toured the facility grounds.

This home consists of (4) bedrooms, 2 full-bathrooms, office, dinning area, kitchen, living room and an attached garage. There are (3) clients residing at this home. (2) out of (3) clients are over the age of 59. Per Facility Administrator an age exemption was submitted to CCLD Monterey Park Office and will follow up with the status. LPA provided Facility Administrator with Title 22, Section 85068.4 A cceptance and Retention Limitations regulations.

COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility, in all common rooms and hallways.

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

All Clients have their own private bedroom.

Medication reviewed for (3) Clients (Client #1 through Client #3).

Per Administrator, all (3) clients are fully vaccinated. Facility Administrator to follow up on the COVID Booster.

PPE supplies observed. They are stored inside the garage. Hygiene supplies are stored inside the garage. All common areas including entrances have a hand sanitizers.

Staff responsible for direct care and supervision were observed wearing masks.

Clients were socially distanced according to local public health guidelines.

Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Facility Administrator