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 Victor Taclob and explained the purpose of the visit. The facility is licensed for four (4) level 3 non-ambulatory developmentally disabled clients ages 18-59 years old. The facility is serviced by the San Gabriel/Pomona Regional Center. The facility is a single story home located in a residential neighborhood. It consists of 4 client bedrooms, 2 bathrooms, kitchen, dining room, living room, laundry area in attached garage, and outdoor shaded patio area. The last emergency disaster drill was conducted on 1/18/2022. Administrator certificate expires 5/18/2024.

COVID-19 Infection Control signs were observed in the entrance, bathrooms, and throughout the facility.. Screening protocols are in place. The facility has an approved mitigation plan.

Staff was observed wearing a mask. Clients in care do not wear a mask due to cognitive impairment.

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

Two (2) 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.

*** NOTE: Facility shall submit Infection Control Plan to CCL.

Exit interview was conducted with Staff Victor Taclob. A copy of the report was issued.