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 home consists of (4) bedroom, (2)bathrooms), living room, kitchen and dinning area.

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

Per S-1, (5) clients have both COVID vaccines and have the booster. (1) Client/C-1 refuses to be vaccinated.

Per S-1, (7) staff have both COVID vaccines and have the booster.

Bathrooms have hand soap and paper towels. Hand washing signs were observed inside both bathrooms.

Hygiene items are stored inside the hallway closet.

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

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

Staff responsible for direct care and supervision were wearing masks.

Clients were socially distanced according to local public health guidelines.

Medication reviewed for (6) Clients (Client #1 through Client #6).

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