Facility Evaluation Report

Licensing Program Analyst (LPA) Lopez conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA was met by DSP Christina Renner and Administrator Kirsten Pouri arrived a short time later and LPA explained the purpose of the visit The facility is licensed to serve 3 developmentally disabled adults ages 18- 59 During the today's visit, LPA toured the physical plant. The facility provides transportation services and is equipped with 1 van. Administrator certificate expires 11/25/2022. The last fire/disaster drill was conducted on 5/17/2022.

Physical Plant : The facility is a single story family home located in a residential neighborhood. The facility consists of a living room, kitchen, dining area, three (3) bedrooms, two (2) bathrooms, detached garage with a laundry area, and outdoor areas. Bathrooms are clean and operational. Facet in shower in bathroom #2 is leaking. Hot water temperature measured 121.1 to 123.9-degree Fahrenheit. Shower water in bathroom number 2 measured 92.6 which is not within regulation.

· Programming is in place with limited client occupancy.

· COVID-19 Infection Control screening, signs to promote hand washing, cough/sneeze etiquette, and physical distancing were observed in the entrance, common areas, hallways, and bathrooms. Facility has an approved COVID-19 mitigation plan.

· Disinfectant products are locked and inaccessible to clients.

· Restrooms have sufficient soap and posted hand washing signs.

· Clients private rooms act as COVID-19 isolation room if needed.

· Personal Protective Equipment (PPE's) of more than 30 days were observed.

· Staff were observed wearing masks. Due to cognitive disability clients were not wearing masks.

· A posted Emergency Disaster Plan and emergency food supply and water were observed.

Exit interview was conducted with Administrator Kirsten Pouri. A copy of the report was provided.