Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on Infection Control Practices. LPA met with RN Sally Wu and explained the purpose of the visit telephonically to Administrator Hazel Gatan. This facility is licensed as an Adult Residential Facility for Persons with Special Healthcare Needs (ARFPSHN) vendored by San Gabriel/Pomona Regional Center. The facility serves four (4) developmentally disabled clients ages 18 and above; of which four (4) may be bedridden. A total of 19 staff members provide care and supervision to the clients. The facility is a single-story home that contains four (4) bedrooms fully equipped with mechanical lifts, two (2) bathrooms of which one (1) is equipped with a mechanical lift, a living room, family room, kitchen, dining room, laundry room, backyard shaded patio area, and attached garage. The last fire drill was conducted on 12/6/2022. Administrator certificate expires 6/9/2024.

The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility is equipped with a sprinkler system. The facility has three (3) fully charged fire extinguishers.

COVID-19 Infection Control Practices and signs that promote hand washing, cough/sneeze etiquette and physical distancing were observed in the entrance, common areas, hallways, bathrooms and client rooms. There is a screening station at the entrance of the facility to screen visitors. Each client room is designated as a COVID-19 isolation room if needed. Facility has an Infection Control & COVID-19 Mitigation Plans.

Oxygen tanks were observed to be secured on stands. The back-up power supply is located on the side of the garage. Mechanical lifts in bedrooms and bathrooms are operational.

Client files have Individual Health Care Plans (IHCP). 30-day supply of client medications were observed locked and given as prescribed. Two (2) clients have a G-Tube.

The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food.

A posted Emergency Disaster Plan was observed. Facility has an adequate 30-day+ supply of Personal Protective Equipment (PPEs), emergency supplies, and daily consumables supplies. Cleaning supplies and toxic substances are locked/ inaccessible to clients.

Staff files were reviewed for criminal background clearance. Two (2) staff (S1 & S2) do not have criminal record clearance. Corporate staff was advised to contact Caregiver Background Check Bureau regarding pending clearance of S1, and to complete Guardian clearance request for S2.

Per California Code of Regulations, Title 22, a deficiencies and civil penalties were cited.

Exit interview was conducted with RN Sally Wu. A copy of the report and appeal rights were issued.