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 home consists of (4) private rooms, (2) restrooms, kitchen, dinning area, living room and detached garage. All clients receive case management services provided by San Gabriel Pomona Regional Center.

Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed. COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and throughout the facility.

PPE supplies observed. Additional supplies observed inside the hallway closet and detached garage.

Hygiene supplies observed (stored/locked inside the hallway closet).

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.

Medication reviewed for (4) Clients (C-1 through C-4). Medication is locked inside the medication cabinet located in the living room.

Per S-1, C-1 through C-4 are vaccinated and have their booster. Clients were be socially distanced according to local public health guidelines.

Per S-1, all staff are vaccinated and have their booster except for S-2. However, S-2 undergoes weekly COVID-19 testing.

Staff responsible for direct care and supervision will wear masks.

Exit interview conducted, a copy of this report and Appeal Rights were provided to S-3.