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 Michael White and discussed the purpose of today's visit.

The facility is to serve 4 ambulatory individuals age 18 through 59 years old. Per Mr. White, he currently working on becoming vendored through the Regional Center. There are (0) clients residing at this facility.

This is a two story home. The first floor consists of a living room, office, dinning room, kitchen, (1) bathroom and laundry room. The second floor consists of (3) bedrooms and (1) bathroom.

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

PPE supplies observed (gowns, masks, hand sanitizer, face shields and gloves).

Non-perishable foods for 7 days observed. Perishable supply will be added prior to admitting the first client.

Medications were not reviewed as there are no clients residing at this facility.

Per Mr. White, facility will implement the mitigation plan and infection control procedures prior to the first client admission into this facility.

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