Facility Evaluation Report

Licensing Program Analyst Lopez conducted an unannounced annual inspection visit. LPA was allowed entry to this home by the Facility Administrator Floresita LIm. LPA discussed the purpose of today's visit. This home is for Developmentally Disabled individuals ages 18 to 59. The (5) Clients residing at this home receive case management services provided by San Gabriel Pomona Regional Center. Annual licensing fees are current.

This is a single story home with 4 bedroom (one of which is designated for staff), 3 bathrooms, living room, den, office, kitchen and dining area.

· COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept.

· Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote handwashing, cough/sneeze etiquette, and physical distancing.

· Facility has one designated isolation room.

· Three client rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· Three client rooms were equipped with alcohol-based hand sanitizer.

· Five (5) centrally stored client medication records were reviewed.

· Staff responsible for direct care and supervision were not observed wearing masks initially.

· Some clients were not observed wearing masks but adhering to public health social distance guidelines.

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

· A posted Emergency Disaster Plan was observed posted at facility.

· Staff and resident files were not reviewed during today's visit.

Deficiencies cited per Title 22 Health and safety code, See 809D for details.

Exit interview was conducted with Administrator Floresita LIm. A copy of the report and appeal rights was provided.