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 is a single home with 4 bedrooms, 2 bathrooms, living room, kitchen, dinning area with an attached garage. All (3) 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. Hand washing signs also posted inside the bathrooms.

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

Hygiene supplies observed. Additional supplies stored inside the hallway closet.

Incontinence supplies observed inside the attached garage.

Restrooms have hand soap, hand sanitizer and paper towels.

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

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

Per S-1, (3) clients and staff are fully vaccinated including the Booster.

Per S-1, (4) staff are fully vaccinated. Boosters are pending. .

Staff responsible for direct care and supervision will wear masks.

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