Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Administrator Mohammed "Raymond" Shirazi and explained the purpose of the visit. There are four (4) level 4N developmentally disabled resident; of which three (3) are 60 years and older. The facility is serviced by Eastern Los Angeles Regional Center. The facility is a single story home located in a residential neighborhood that is licensed for 1 non-ambulatory residents and 3 ambulatory residents. It consists of 4 resident bedrooms, 1 staff room, 2 full bathrooms, living room/dining area, laundry/office area, kitchen, and detached garage. The last fire drill was conducted on 1/30/2022. Administrator certificate expires 11/16/2022.

The interior and exterior physical plant was inspected. Staff were observed wearing surgical masks.

COVID-19 Infection Control screening and signs were observed in the entrance area, and bathrooms.

Facility has an approved COVID-19 Mitigation Plan.

Each resident room is designated as a COVID-19 solation room if needed.

Two (2) centrally stored resident medication record was reviewed.

Residents in care do not wear masks because it is not tolerated due to developmental disability.

Sufficient supply of perishable for 2 days & non-perishable foods for 7 days was observed.

Personal Protective Equipment (PPEs) were observed.

*** Age Exception for 3rd resident over the age of 60 was not processed/approved in October 2018 because the Regional Center support letter was not submitted. LPA spoke with Christopher Trevilla today.

Exit interview was conducted with Administrator Mohammed "Raymond" Shirazi. A copy of the report was issued.