Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Marijan Tekeian, Family member and explained the purpose of today's visit. Administrator/Licensee Diana Tekeian is unavailable and out of town. At, 10:10am, Ana Papazyan, Marketing Manager arrived and assisted LPA with the inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan. Infection Control Plan was not reviewed as Marketing Manager cannot locate the file. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff will adhere to infection control requirements.

Operational Requirements : A current Plan of Operation was not reviewed, as Marketing Manager cannot locate the file. A fire clearance is in place. Liability Insurance policy in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 6/18/2024. No fire drill has been conducted yet.

Physical Plant/Environment Safety: The facility is a single story h ome located in a residential neighborhood that is licensed to serve 5 ambulatory residents ages 60 and over, of which (1) may be bedridden and (1) may be non ambulatory in bedroom #3. There is also a hospice waiver for (2). There is zero (0) resident in the facility during the visit. Home consists of three (3) bedrooms, (2) bathrooms, living room, dining room, family area, kitchen, backyard, and a detached garage. The fireplace in the living room is adequately screened. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Currently, there is a construction going on in the front yard and the back yard. According to the Marketing Manager, the on-going construction is to fix plumbing issues and landscaping. Smoke and carbon monoxide detectors are operational. The facility has (2) fire extinguishers in the facility that are fully charged, one mounted on the wall in the living room and the other one in the kitchen. Cleaning supplies and toxic substances are stored in a locked cabinet. At 9:45am, hot water temperature readings measured 111.7 deg F in bathroom #1 and 108.1 deg F in bathroom #2 which are within the required 105-120 degrees Fahrenheit.