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. LPA toured the facility grounds.

This home consists of (3) bedrooms, 2 full-bathrooms, living room. kitchen, dinning area, laundry room, office and an detached garage. There are (6) clients residing at this home. All clients 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, in all common rooms and hallways.

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

Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed. Additional food supply is stored inside the garage.

PPE supplies observed. They are stored inside the office and inside the detached garage.

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

Clients were socially distanced according to local public health guidelines.

Per S-1, all (6) clients are fully vaccinated. COVID Booster to be determined.

Per S-1, (4) staff are fully vaccinated and (3) staff receive COVID testing on a weekly basis. COVID Booster to be determined.

Exit interview conducted, a copy of this report and Appeal Rights were provided to S-1.