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), (2) bathrooms, living room, kitchen, dinning area and 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.

PPE supplies observed. Additional supplies are stored inside the garage.

Restrooms have hand soap, hand sanitizer and paper towels.

Additional toilet paper and napkins are stored inside the garage.

Additional hygiene supplies are are stored inside the garage.

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

Per S-1, all (6) clients are fully vaccinated. (5) out of (6) clients have the COVID-19 Booster.

Per S-1, all staff are fully vaccinated and have the COVID-19 Booster.

Medication reviewed for Client #1 through Client #6 (C-1 though C-6).

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/Facility Administrator.