Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez and Bennette Pena conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPAs met with Administrator Monique Jordan and explained the purpose of the visit. Home is Level 4 Home. The home has 6 ambulatory clients, none have a restricted health care condition and all clients are between the ages of 18-59. Facility is a two story home located in a residential area consisting of 2 private rooms and 2 shared rooms,2 bathrooms, living room, dining room, backyard patio area, and detached garage. The last fire drill was completed on November 18, 2021. Administrator certificate expires 4/06/2023

· 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 hand washing, cough/sneeze etiquette, and physical distancing.

· Facility has one designated isolation room.

· 2 share and 2 private rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· All client rooms were not equipped with alcohol-based hand sanitizer but available throughout the facility

· Six (6) centrally stored client medication records were reviewed.

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

· Clients were not observed wearing masks but adhering to public health social distance guidelines.

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

· A posted Emergency Disaster Plan was observed.