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

This home consists of (2) private client bedrooms, (1) shared bedroom, (1) bathroom, living room, den/T.V. room, kitchen, dinning area, laundry room and attached garage. LPA toured grounds. 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. These items are stored inside the garage.

Bathroom has hand soap and hand sanitizer.

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

Per Administrator, all (4) clients are fully vaccinated including booster.

Medication reviewed for (4) Clients (Client #1 through Client #4).

Per Administrator, all staff are fully vaccinated including booster.

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 S-1/Facility Administrator.