Facility Evaluation Report

Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPA met with Administrator Teodora Manohon who assisted with visit.LPA explained the reason for the visit. The facility is licensed for residents age range 60 and over. Approved for 2 ambulatory and 4 non-ambulatory residents.

The facility is a single story structure located in a residential neighborhood. It consists of the following: (4) resident bedrooms, (1) staff bedroom, (1) resident bathroom, (1) staff bathroom, kitchen, dining area, living room, attached garage. laundry area located in the garage. Laundry detergent and cleaning supplies observed in the garage locked and inaccessible to residents. LPA toured the facility. All indoor and outdoor passageways were free of obstruction. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. The kitchen was inspected. LPA observed all kitchen equipment to be clean and in working condition. LPA observed sufficient supply of 2 day perishable and 7 day non-perishable foods. LPA observed 3 refrigerator / freezer in the garage. Sharps are locked in the kitchen and inaccessible to residents. Smoke / Carbon monoxide detectors were in compliance and operational. Fire extinguisher located in the kitchen and fully charged. The common areas are clean and were properly furnished. Resident rooms were sanitary and had the required furniture and furnishings. The resident bathroom is clean and operational w/grab bars and non-skid surface/mats in place. The hot water temperature was tested and maintained within the required range of 105-120*F. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. LPA reviewed residents files to confirm emergency contact is updated.