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 discussed the purpose of today's visit. All clients residing at this receive Case Management services provided by San Gabriel Pomona Regional Center. All clients residing in this home are between the ages of 18 through 59.

This facility consists of (3) bedrooms, (2) bathrooms, kitchen, dinning area, living room, den and detached garage.

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

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

Restrooms have hand soap and paper towels.

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

Per S-1, all (4) clients have both vaccines and 1st booster.

Per S-1, there are (6) staff members have both vaccines and 1st booster.

Medication reviewed for (3) Clients (Client #1, Client #3 and Client #4). Client #2 does not take medication.

Staff responsible for direct care and supervision will wear masks.

Per Administrator, the infection control plan has been submitted to CDSS. Exit interview conducted, a copy of this report and Appeal Rights were provided to S-1.