Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPAs met with S-1 and explained the purpose of the visit.

This home consists of 3 bedrooms, 2 baths, kitchen, dinning area, den/game room, living room and attached garage.

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

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

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

Restrooms have hand soap and paper towels.

Hand sanitizers observed in common areas throughout this facility.

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

Per S-1, all (3) clients have both vaccines and 1st booster.

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

Clients social distance according to local public health guidelines.

Per S-1, there are (5) staff members have both vaccines and some have a pending booster.

Staff responsible for direct care and supervision will wear masks.

The infection control tool was sent to LPA via e-mail today (during today's visit).

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