Facility Evaluation Report

Licensing Program Analyst (LPA) Tyler Reyes conducted an unannounced Required 1 year inspection at the facility and met with Licensee/Administrator Maria Pliss and explained the purpose for todays visit. The facility is licensed to serve four (4) Developmentally Disabled Adults ages 18-59. Two (2) Non-Ambulatory.

The facility is a snigle story home consisting of four (4) bedrooms, one (1) staff room, (2) bathrooms, living room, dining room, kitchen, laundry area, a detached garage, and a front and backyard. There are no bodies of water at this location. Last Emergency Disaster Drill was on 7/17/24 and Administrator Maria

· COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept.

· Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote handwashing, cough/sneeze etiquette, and physical distancing.

· Four client rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· Four (4) centrally stored client medication records were reviewed.

· Staff responsible for direct care and supervision were observed wearing masks.

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

. Five (5) staff files were reviewed -criminal record clearance, current first aid, CPR and CPI. Staff files are maintained at the facility and kept in a secured location..

. Four (4) clients files were reviewed -Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan.