Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted the required annual inspection. LPA arrived unannounced and met with DSP Monika Tagvoryan who allow LPA entry and Administrator Romik Rostomyan arrived a short time later and assisted with the inspection today. The facility is licensed for 6 residents ages 60 and over. The fire clearance is approved for Six (6) non-ambulatory residents of which 1 can be bedridden. There is a hospice waiver approved for 2 residents. Currently there are 5 residents at the facility.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents with medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan needs updating.

Operational Requirements: A current Plan of Operation was reviewed. 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 10/05/2023. The last fire Drill was conducted on 02/05/2023. Care and supervision to meet the residents needs was observed.

Physical Plant & Environment Safety: The facility is a single-story building. Common areas, including the living room, dining room, all appeared clean and were properly furnished except some rooms are missing chairs. The kitchen appeared clean and the appliances and fixtures functional. Entry/exits were free of obstruction. The medications were locked in the medication room. The 3 resident rooms were inspected, and the water temperature measured between 121.6-126.3 degrees F which is not within range of 105 – 120 degrees F.

Staffing : There appears to be sufficient staffing at the facility. The Administrator’s certificate expires 11/18/2024 Staff employed are all over the age of 18.

Personnel Records-Training : Staff files are maintained at the facility. Staff have current CPR/first aid training and evidence of some on-going training .