Facility Evaluation Report

Licensing Program Analyst (LPA) Danyle Wolter arrived at the facility unannounced to conduct a Required 2 Year inspection. Upon LPAs arrival, S2 and S3 were present and contacted administrator, Narine Hannesyan (certificate # 6034425740 exp 3/31/19) , who arrived at 9:15am. Facility has a hospice waiver for three (3) and currently has one (1) resident on hospice.

LPA conducted a file review at 9:20 am of two (2) staff records. S2 has criminal background clearance but is not associated to the facility, S3 has no criminal background clearance and is not associated to the facility. S1 and S2 do not have current First Aid training (exp 3/31/2017), staff has not completed twenty (20) hours of training in 2018. LPA reviewed five (5) residents files and found the files to be incomplete. R1 and R5 do not have physician reports, R1, R2, and R5 do not have Pre-Admission Appraisals, and R3 and R4 do not have reappraisals which have been completed in the last 12 months.

LPA and administrator toured the facility together at 9:50am, including but not limited to: common living spaces, resident bedrooms; bathrooms, staff room/office, kitchen, and backyard. Facility has a garage in the backyard that was locked and administrator did not have a key to open it for inspection. Residents bedrooms and bathrooms were clean and in good repair, water temperature measured at 105.6 degrees F in resident bathroom. LPA observed adequate supply of extra towels and linens. Food supply for 2-day perishable and 7-day non-perishable was adequate. There is a pool in the backyard, pool is surrounded by a gate and is locked and inaccessible to residents. LPA observed fire extinguisher is fully charged and was purchased 10/28/18. LPA observed smoke detectors are present throughout the facility and are dual units with carbon monoxide detectors built in, they were tested and in working order.