Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual inspection. LPA met with Cori Waters who stated is lead at facility. Licensee Luther Waters arrived a short time later. The facility has an approved fire clearance for two (2) ambulatory residents, one (1) non-ambulatory and zero (0) bedridden. All three current clients are ambulatory. The facility is a single-story home with three (3) client’s bedrooms, three (3) clients' bathrooms, a den, a kitchen, a dining room, a living room, administrator office, and a laundry room. The facility is in a residential neighborhood. This facility last fire drill was on 12/15/2015 Co- Administrator Cori Waters certificate has expiration date of 07/30/22

LPA took a tour of the physical plant including the inside and outside of the house.

· 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 designated isolation room.

· Three (3) client rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· Facility is equipped with alcohol based hand sanitizer.

· Three (3) centrally stored client medication records were reviewed.

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

· Clients were 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.

· Staff and resident files were not reviewed during today's visit.

Exit interview was conducted with Assistant Administrator Luther Waters. A copy of the report was provided.