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/Facility Administrator and explained the purpose of today's visit.

This is a single story home that consists of: (4) private bedrooms, (2) bathrooms (one bathroom is located inside a client bedroom), living room, kitchen, dinning room, activity room and an attached garage. The laundry unit is set-up inside the garage.

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

PPE and hygiene supplies observed. Additional, hygiene supplies are stored inside a locked garage cabinet.

Bathroom has hand soap and hand sanitizer.

Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed. Additional freezer with food supply observed inside the garage.

Per Administrator, Client #1 through Client #3 (C-1 through C-3) clients are vaccinated. Client #4 (C-4) refuses to get the vaccine(s).

Medication reviewed for Client #1 through Client #4. Medication is stored and locked inside a kitchen cabinet.

Per Administrator, all staff are fully vaccinated including booster.

Staff responsible for direct care and supervision will 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 S-1/Facility Administrator.