Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with S-1 and discussed the purpose of today's visit.

Facility Administrator arrived at approximately 12:10 P.M..

This home consists of (4) bedrooms, (2) bathrooms, kitchen, dinning room, living room, den/family room, laundry room and attached garage. Facility grounds toured.

COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and throughout the facility. Posted signs also promote hand washing, cough/sneeze etiquette and physical distancing.

PPE supplies observed. Per Facility Administrator, there is approximately 60 days worth of PPE supplies readily accessible.

Hygiene supplies observed inside the hallway closet. Each client has their own hygiene storage box. The facility has additional hygiene supplies readily available for Clients as well.

Restrooms have hand washing signs, hand soap and hand sanitizer.

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

Medication reviewed for (3) Clients (Clients #1 through Clients #3).

Per Administrator, all (6) Clients are fully vaccinated and have their booster.

Per Administrator, all staff are fully vaccinated. (1) staff has their booster pending.

Staff responsible for direct care and supervision will continue to wear masks.

Clients were be socially distanced according to local public health guidelines.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Facility Administrator.