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 explained the purpose of today's visit. Facility Administrator arrived at approximately 12:45 P.M..

This home consists of (5) bedrooms (3 of which are client occupied), (2) bathrooms, living room, kitchen, dinning area, recreation room, laundry set-up is inside the 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 supplies and hygiene supplies observed. They are stored inside the hallway closet.

Restrooms have hand soap and hand sanitizer. Hand sanitizers were observed in common areas as well.

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

Per Co-Administrator-All (6) clients are fully vaccinated and have their Booster.

Per Co-Administrator-All (7) staff working at this facility are fully vaccinated and have their 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 Facility Administrator. Note: LPA experienced technical difficulties during today's visit.