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 story home that consists of: (5) bedrooms, (3) bathrooms, living room, kitchen, dinning room, family room and an attached garage. The laundry unit is set-up near the kitchen.

COVID-19 Infection Control Practices signs were posted throughout the facility.

PPE supplies observed at the entrance. Additional PPE supplies are stored inside the hallway closet.

Hand sanitizer and sanitizer wipes observed throughout the facility.

Hygiene supplies observed. Additional supplies are stored inside the hallway closet.

Incontinence supplies observed. Additional supplies are stored inside the hallway closet.

Restrooms have hand soap, hand sanitizer and have paper towels.

Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed. Emergency food supply was stored inside the hallway closet.

Per S-1, C-1 is fully vaccinated including the booster.

Per S-1, all (3) staff are fully vaccinated including the booster.

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