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. This home consists of: (4) bedrooms, (3) bathrooms, living room, kitchen, dinning area, den and an attached garage,

COVID-19 Infection Control Practices signs were observed.

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

Client bedrooms inspected. There are (2) client private bedrooms and (1) shared client bedroom.

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

PPE supplies observed. Additional PPE supply is stored inside the office.

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.

Clients were socially distanced according to local public health guidelines.

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