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 John Nguyen and explained the purpose of the visit. There are four (4) clients level 4 specialized developmentally disabled clients ages 59 and under. Facility is a two-story home licensed for 6 non- ambulatory clients. It is located in a residential area consisting of five (5) client bedrooms, (1) staff rooms, 3 bathrooms, kitchen, dining room, laundry room, living room, family room, patio area, and attached garage. The facility is equipped with a sprinkler system. The last fire inspection was conducted on 5/26/2022 by San Marino Security Systems Inc. The last emergency disaster drill was completed on 3/10/2022. Administrator certificate expires 10/1/2022.

COVID-19 Infection Control Practices were observed upon entry and in common areas.

Infection control signs, and other signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.

Each client bedroom is designated as COVID-19 isolation room if needed.

Hand sanitizer was observed in common areas.

Staff responsible for direct care and supervision were observed wearing a mask.

Clients were not observed wearing masks in the home due to cognitive impairment.

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

A Emergency Disaster Plan was posted. Please update if needed.

Sufficient supply of Personal Protective Equipment (PPEs) was observed.

Four (4) centrally stored medication records were reviewed.

Exit interview was conducted with Administrator John Nguyen. A copy of the report was issued.