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

This home consists of 4 bedrooms, 2 bathrooms, living room, kitchen, and dinning area. All clients residing at this home 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.

Incontinence supplies observed/stored inside the attached garage.

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.

Per Administrator, all (6) clients are fully vaccinated including the 1st booster vaccine.

Per Administrator, all staff are fully vaccinated including the 1st booster.

Medication reviewed for (6) Clients (Client #1 through Client #6).

Staff responsible for direct care and supervision will wear masks.

Clients were socially distanced according to local public health guidelines.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Facility Administrator