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 Facility Administrator and explained the purpose of today's visit.

This home consists of (4) bedrooms, (2) bathrooms, living room, kitchen, dinning area, laundry room and 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 throughout the facility. Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.

PPE supplies observed inside a cabinet (dinning area). Additional PPE supplies are stored inside garage.

Hygiene and incontinence supplies observed. Items stored inside the garage.

Restrooms have hand soap, hand sanitizer and paper towels. Hand sanitizer observed throughout the facility.

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

Per Administrator, (3) clients and staff are fully vaccinated including the Booster.

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

Staff responsible for direct care and supervision will wear masks.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Facility Administrator.