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 S-1 and explained the purpose of today's visit.

This home consists of (3) private client bedrooms, (2) bathrooms, living room, kitchen, dinning area, laundry set-up is inside the attached garage. LPA toured grounds. All Clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center.

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

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

Restrooms have hand soap and hand sanitizer.

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

C-1 and C-2 are fully vaccinated. Booster pending/to be determined.

There are (7) staff working at this facility. (3) out of (7) are fully vaccinated and have the booster. (4) out of the (7) have exemptions and are tested weekly.

Medication reviewed for (2) Clients (Client #1 and Client #2).

Staff responsible for direct care and supervision will wear masks.

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 S-2