Facility Evaluation Report

On 12/31/24, 9:15 am , Licensing Program Analyst (LPA) Raymond Comer conducted an unannounced Annual visit to this facility. LPA met with Facility Administrator, Khachatryan Verzhine, and reason for the visit was discussed.

Facility is licensed as a single-story residence, approved for six (6) non-Ambulatory, with one (1) bedridden. Hospice waiver for six (6). Facility has four (4) resident bedrooms, and two (2) bathrooms.

At 9:25 am, LPA conducted a tour of the physical plant with the Administrator and observed the following:

Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Alternative exits are located in all bedrooms. Visitor sign-in sheet, hand sanitizer, gloves and masks are available. Covid 19 prevention protocols are posted. Room temperature is comfortable; wall thermostat displays a setting of 75.0°F . within the required range. An approved Mitigation and Infection Control plan is on file. Hand washing, coughing etiquette, and other necessary signage are prominently displayed throughout the facility. Required postings observed to be current. Disaster drills were last conducted on 12/2024.

Fire Detection/Protection system is present in the facility. Dual Smoke and Carbon monoxide detectors function properly. LPA observed a fire extinguisher located on the wall near the kitchen. Extinguisher displays service date: 12/2024.