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 explained the purpose of today's visit.

This is a single story home which consists of a 3 bedrooms, 2 bathrooms, kitchen with a dinning area, living room, laundry room and office.

Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.

COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and throughout the facility.

Bathrooms had hand soap and hand sanitizer.

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

Per S-1, (3) clients have both vaccines and 1st booster. (1) client only has (1) vaccine and has refused the 2nd vaccine and booster.

Per S-1, there are (9) staff total. Breakdown: (7) staff have both vaccines and 1st booster. (2) staff have religious exemption s on file and both staff are tested weekly (S-1 and S-2).

Medication reviewed for (3) Clients (C-1, C-3 and C-4). C-2 does not take medication.

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

Staff responsible for direct care and supervision will wear masks.

Exit interview conducted, a copy of this report and Appeal Rights were provided to S-1.