Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with RN Cristal Parra and explained the purpose of the visit. Program Director Giovanni Camponovo arrived later. This facility is licensed as an Adult Residential Facility for Persons with Special Healthcare Needs (ARFPSHN) vendored by San Gabriel/Pomona Regional Center. The facility serves five (5) developmentally disabled clients ages 18 and above; of which five (5) may be bedridden. A total of 14 staff members provide care and supervision to the clients. The facility is a single-story home that contains five (5) bedrooms fully equipped with mechanical lifts, two (2) bathrooms fully equipped with mechanical lifts, a living room, family room, kitchen, dining area, laundry room, office, backyard/shaded patio areas, and attached garage. The last fire drill was conducted on 9/16/2022 & the last fire inspection was completed on 7/5/2022. Administrator certificate expires 9/6/2023.

The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility is equipped with a sprinkler system. The facility has two (2) fully charged fire extinguishers.

COVID-19 Infection Control Practices and signs that promote hand washing, cough/sneeze etiquette and physical distancing were observed in the entrance, common areas, hallways, bathrooms and client rooms. There is a screening station at the entrance of the facility to screen visitors. Each client room is designated as a COVID-19 isolation room if needed. Facility has an Infection Control & COVID-19 Mitigation Plans.

Oxygen tanks were observed to be secured on stands. The back-up power supply is located in the garage. Mechanical lifts in bedrooms and bathrooms are operational.

Client files have Individual Health Care Plans (IHCP). 30-day supply of client medications were locked, documented properly, and given as prescribed.

The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food.

A posted Emergency Disaster Plan was observed. Facility has an adequate 30-day+ supply of Personal Protective Equipment (PPEs), emergency supplies, and daily consumables supplies. Cleaning supplies and toxic substances are inaccessible to clients.

Two (2) staff (S1 & S2) have criminal record clearances but are not associated to the facility. Guardian Transfer request was completed today and the deficiency was cleared.

Per California Code of Regulations, Title 22, a deficiency was cited.

Exit interview was conducted with Program Director. A copy of the report and appeal rights were issued.