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 discussed the purpose of today's visit.

This facility consists of (4) bedrooms, (2) bathrooms, living room, kitchen, dinning room, laundry room and an attached garage. 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 the dinning area.

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

PPE supplies observed. Additional PPE supply observed inside the locked medication closet and inside the attached garage.

Bathrooms have hand soap and paper towels. Hand washing signs will be posted.

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

Emergency supply backpacks were also observed inside the attached garage.

Medication reviewed for (1) Client #1 (C-1). C-2 and C-3 do not take medication.

Staff responsible for direct care and supervision will wear masks.

LPA discussed the infection control plan and reminded S-1 of due date of 06/30/2022.

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