Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA was allowed entry by S-1 and explained the purpose of today's visit. Facility Administrator arrived at approximately 10:15 A.M..

COVID-19 Infection Control Practices (including signs) were observed.

Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.

Client bedrooms inspected. Each Client has their own bedroom.

30 day supply of medication reviewed for (4) clients (C-1 through C-4).

PPE supplies observed. Additional PPE supplies are stored inside the garage.

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

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

Clients were socially distanced according to local public health guidelines.

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