Facility Evaluation Report

Licensing Program Analyst's(LPA) Vasallo and Yang conducted an annual required visit. LPA's met with Staff #1 (S1) and explained the reason for the visit. Administrator was called and notified of the visit. LPA's used the infection control tool to evaluate the facility. LPA's observed the physical plant, COVID-19 procedures, reviewed clients' medications and records, staff records and observed the food supply. The facility cares for intellectually disabled adults and is vendorized by San Gabriel/Pomona Regional Center.

All client bedrooms were toured. Bedrooms have the required bed, bedframe, linen, dresser, light, and closet space. Client bathrooms were toured and the hot water was 105.8 degrees which is within the required 105 - 120 degrees. The hallway bathroom has tile missing from the sink. According to staff, the tile broke off. There were no toxic chemicals accessible to clients. The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are clean and are operating properly. There is a second refrigerator in the garage with additional food. The common areas include the living room and dining area. These areas are clean and have the required furniture. Facility currently has at least a 30-day supply of PPEs. There are no cameras inside the facility. There is a screening station at the entrance of the facility to screen visitors. Staff document client and staff temperatures and symptoms daily.

All 5 client files were reviewed to confirm emergency contacts and physician's reports. 4 staff files were reviewed to confirm health screenings, training and fingerprint clearances. All files were complete. All clients' medications were reviewed. Medications are documented properly and given as prescribed.

Per California Code of Regulations, Title 22, the deficiency observed is documented on the attached 809D. Exit interview held. A copy of the report and appeal rights were provided.