Facility Evaluation Report

LPA Alberto Lopez made unannounced case management visit to facility to follow-up on office visit of 04/26/2022 LPA met with Administrator Tina Arutyunyan and discussed the purpose of the visit .

LPA took tour of the 4 bedrooms and outside plant All the rooms had the required furniture and were clean. LPA measure the water temperature in 3 bathrooms and kitchen and it measured 107.6 in Bathroom #1 sink, tub in room #1 was 88.0 degrees, In bathroom #2, temperature was 87.2 Bathroom #4 and kitchen measured at 87.2. Bathroom in room #4 is uncleaned on the window sill and the screen is in disrepair and need too be repair or replaced. LPA reviewed P & I Logs for 2 residents and it was in order. 7 days of Non-perishable and 2 days of perishable food were observed, 1 bedridden residents was in room not designated for bedridden. Administrator has clearance for 2 bedridden residents in room #1 only. Administrator notified fire department on Tuesday 11/29/2021 - Danny King about getting bedridden fire clearance for 6 residents . It was discussed with R1 and administrator that R1 needs to move to room #1 unless his MD designates R1 as Non-ambulatory or fire clearance is granted to facility.

deficiencies cited (see 809D for details)

Exit interview was conducted with Administrator Tina Arutyunyan and copy of report and appeal rights provided.