Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection on 5/9/25. LPA met with Staff, Aileen Ayson, and explained the purpose of the visit. The facility is licensed to serve 6 residents ages 60 and over, of which 5 may be non-ambulatory and 2 bedridden. There is a hospice waiver approved for 2 residents.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.

The single story facility consists of 4 resident bedrooms, 2 bathrooms, living room, dining/kitchen, laundry area, and the attached garage. The backyard has a shaded area for resident use. The hot water temperature was measured between the required range of 105-120 degrees F. There is no swimming pool on the premises. The facility has a carbon monoxide detector located in the hallway and smoke detectors in each resident room. Sufficient food supplies of 2 day perishable and a week of non-perishable are observed. Facility has sufficient space to provide indoor and outdoor activities to residents. Facility accepts and retains residents with dementia. Staff are ensuring that incontinence residents are changed often and the facility remains free of odor from incontinence. There are currently no residents with a prohibited or restricted health condition. No residents are using oxygen equipment. Medications are centrally stored and locked in the kitchen cabinet. LPA reviewed 5 resident files and medications. Medications are being administered as prescribed. The files have the required documents. LPA reviewed 3 personnel files. Administrator's (Helen Abeshyan) certificate expires on 5/15/25. The files have the required forms and annual training are being provided to staff. The Emergency Disaster Plan is updated. LPA provided a technical advisory for the emergency disaster drill.

No deficiency was issued today. An exit interview was held and a copy of this report was given to the administrator.