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. Facility Administrator arrived at approximately 1:00 P.M and assisted with this visit.

All Clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center. This home has (4) bedrooms, (2) bathroom, living room, dining room, family room and attached garage.

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. Sings also posted inside the bathrooms.

PPE supplies observed. These items are stored inside the garage.

Hygiene supplies observed. Items stored inside the garage.

Bathrooms have hand soap, paper towels and hand sanitizer.

Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed. An additional refrigerator and freezer with additional food was observed inside the attached garage.

Per Administrator, (3) clients are fully vaccinated.

Per Administrator, staff are fully vaccinated.

Medication reviewed for (3) Clients (Client #1 through Client #3).

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 Facility Administrator.