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 DSP staff Karla Williams and explained the purpose of the visit. There are six (6)) level 4G developmentally disabled clients ages 18-59. The facility is serviced by San Gabriel/Pomona Regional Center. The facility is a single story home located in a residential neighborhood that is licensed for 4 ambulatory and 2 non-ambulatory clients. It consists of 3 bedrooms, 2 bathrooms, living room, family room, dining room, office room, laundry room, kitchen, outdoor covered patio, and attached garage. The last fire drill was conducted on 4/29/2021.

The interior and exterior physical plant was inspected. An unlocked laundry detergent bottle was observed in the laundry room shelf. Staff immediately locked the detergent.

COVID-19 Infection Control signs were observed in the entrance, common areas, hallways, and bathrooms. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.

One (1) room has been designated as a COVID-19 solation room if needed.

Three (3) centrally stored resident medication records were reviewed.

Staff was observed wearing a surgical mask.

Clients in care do not wear masks because it is not tolerated due to cognitive impairment.

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

A posted Emergency Disaster Plan was observed.

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

Staff and resident files were not reviewed during today's visit.

Based on record review observation the last disaster drill was conducted on 4/29/2021, and shall be conducted at least every 6 months; which is now past due.

Exit interview was conducted with DSP Felicia Dioron. A copy of the report and appeal rights was issued.