Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Annual visit. LPA was allowed entry into this home by Rizalina Gaetos/S-1. LPA discussed the purpose of today's visit

This home consists of 4 bedrooms, 2 bathrooms, living room. kitchen and dinning room. San Gabriel Pomona Regional Center provides case management services to all (4) clients residing at this facility.

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

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

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

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

PPE supplies observed. Additional supplies stored inside the garage.

Restrooms have hand soap, hand sanitizer and paper towels. Hand washing signs were observed inside both bathrooms. (1) bathroom is located in the hallway and the other is located between bedroom #2 and bedroom #4 (Jack and Jill bathroom).

Medication reviewed for (4) Clients (Client #1 through Client #4). Each client has a designated locker for their medication and files which remain locked at all times.

Per S-1, all (4) clients are fully vaccinated including the 1st booster vaccine.

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 Rizalina Gaetos/S-1