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 home with (4) bedrooms, (2) bathroom, living room, kitchen, dinning area and an attached garage.

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

COVID signs were throughout the facility.

Bathrooms had hand soap, paper towels and hand sanitizer. Hand washing signs observed inside the bathrooms as well.

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

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

Staff responsible for direct care and supervision were wearing masks.

Clients were socially distanced according to local public health guidelines.

Medication reviewed for (3) Clients (Client #1 through Client #3).

Per S-1, (3) clients have both COVID vaccines.

Per S-1, (3) staff have both COVID vaccines.

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