Facility Evaluation Report

Licensing Program Analyst (LPA)s Brian Balisi and Valeria Conway conducted a pre-licensing visit to this property at 09:45AM. LPA's with Lilly Chaparyan and explained the reason for the visit. This application is for a Change of Ownership Application (CHOW) currently operating with Facility license # 195850209 and the current licensed facility has residents in care. The applicant has obtained fire clearance for Ninety Four (94) non-ambulatory and eight (8) bedridden with a total capacity of One hundred and two (102) residents. Chaparyan stated there is a pending hospice care waiver.

The facility is a 2 story residence and consist of a total of eighty (80) apartments. At approx. 10:00am, a physical tour was conducted inside and out. There are fire sprinklers and fire doors throughout the facility.

The kitchen was observed to be inaccessible to residents in care. Knives are kept inaccessible to residents in care. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Dining room furniture were observed to be in good condition and appeared to be relatively clean. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional at the time of the visit. Trash cans had tight fitting lids. No flies or other vermin were observed.

LPA's inspected randomly selected rooms in both memory care and Assisted living. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread.