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. House Manager/Lead Staff arrived at approximately 1:25 P.M..

This home consists of (4) private client bedrooms, (2) bathrooms, living room, kitchen, dinning area, storage room (laundry room inside the storage 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 and hygiene supplies observed (additional supplies stored inside the storage room).

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 supply including water observed inside the garage.

Medication reviewed for (4) Clients (C-1 through C-4).

C-1 through C-4 are vaccinated. C-1 through C-3 also have the Booster. C-4 has the Booster pending.

There are a total of (7) staff working at this facility. (6) staff are vaccinated. (1) is not vaccinated and has an exemption on file.

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 House Manager/Lead Staff.