Facility Evaluation Report

At 9:30am Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an announced Pre-Licensing Inspection and met with the facility administrator Sona Gevorkyan and Licensee Sipan Movsesyan.

An application was submitted to Community Care Licensing Division-CCLD on 02/20/2024, Initial license for a Residential Care Facility for the Elderly, 60 years and older. A fire clearance was approved on May 21, 2024 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six (6). The bedridden fire clearance is for bedrooms #5. Bedrooms #1, #2, #3, and #4, cleared for non-ambulatory residents. Bedroom #6 is cleared for ambulatory resident only. The Licensee also requested a hospice waiver and granted for six (6) residents. The facility is a single-story home.

With the assistance of the Licensee/administrator, a tour of the physical plant was initiated at approximately 10:00am and the following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, dish washer and sink. The kitchen appliances and fixtures were functional. LPA found a sufficient amount of non-perishable food at the facility; properly stored. Perishable food items are not required at this time as there are no residents in the facility. LPA observed dining ware to accommodate a maximum capacity of six (6) residents. Knives and sharps will be stored in a locked cabinet inside the kitchen. Kitchen chemicals are stored in the separate locket closet.

BEDROOMS: There are six (6) bedrooms designated for residents’ use. All bedrooms are furnished and well equipped with beds, nightstand, chair, dresser, bedding, and extra linen. Rooms were observed to have sufficient lighting and closet space. Auditory alarms were tested and observed to be operational at 10:15am. Facility will have awake staff. Emergency call buttons/bells are available and will be provided to residents.