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

This home consists of (3) bedrooms, (2) bathrooms, living room, kitchen, dinning area and attached garage. San Gabriel Pomona Regional Center provides case management to all the clients residing at this facility.

COVID-19 Infection Control Practices (including signs) were observed.

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.

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

Hygiene supplies (including feminine items) observed. Additional supplies are stored inside the garage.

Restrooms have hand soap, hand sanitizer and paper towels. Hand washings signs were also posted.

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

Per S-1, all (6) clients are fully vaccinated and have both boosters.

Per S-1, all staff are fully vaccinated and have both boosters.

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 Elizabeth Stacy/S-1