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 staff Josefina Untalan and explained the purpose of the visit. Administrator Sergio Calderon was explained the purpose of the visit telephonically. House Manager Lilia Dunn arrived shortly after to assist with the visit. There are four (4) level 4h developmentally disabled clients in the home; of which 2 can be non-ambulatory. The facility is licensed for clients 18-59 years old. However, there are 3 residents over the age of 60, which exceeds 50% of census. The licensee must request an exception in order to accept or retain the individual.

The facility is a single story home located in a residential neighborhood. It consists of 4 client bedrooms, 2 bathrooms, kitchen, living room/dining area, shaded patio furniture, and detached garage. The last emergency disaster drill was conducted on 7/11/2022. Administrator certificate expires 11/15/2023.

COVID-19 Infection Control signs were observed in the entrance and bathrooms. Screening protocols are in place. Clients in care do not wear a mask because it is not tolerated due to cognitive impairment.

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

Four (4) centrally stored resident medication records were reviewed. Facility maintains a 30-day supply of medications. Centrally stored medications are kept in a locked closet.

Sharps and chemicals/cleaning supplies are stored inaccessible to residents.

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

A posted Emergency Disaster Plan was observed. Smoke detectors were tested and are operational. Fire extinguishers are fully charged. The facility has a fire pull alarm system.

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

Client files were reviewed. Medical/Specialist Visit Information documents were obtained.

All residents in care were observed to have extremely short hair cuts that appear shaven. Per documentation, "clean short haircut for personal hygiene" was ordered by MD. However, facility did not obtain consent from responsible parties, and the San Gabriel Regional Center stated they were not aware.

Deficiencies are being cited. See LIC 809D.

Exit interview was conducted with House Manager Lilia Dunn. A copy of the report/appeal rights was issued.