Facility Evaluation Report

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced case management visit due to deficiencies observed on a visit to the facility today. LPA Yee conducted visit with Mariam Baghdoyan, Caregiver. Also present during the visit was Emilya Hovsepyan, Caregiver. The reason for today's visit was explained.

The following deficiencies were observed during today's visit:

Resident #1 was sent to the hospital on 1/15/25 and the Licensee did not submit a Special Incident Report to the Department within 7 days

Resident #2, Resident #3, Resident #4 and Resident #5 were observed in hospital beds equipped with full bed rails and they are not on hospice and there was no physician' s order observed in their file.

Resident #2, may or may not be on hospice and the facility failed to report the initiation of hospice to the Department.

Per review of the food supply, there was insufficient perishables, such as fresh vegetables and fruits for a minimum of 2 days and insufficient non-perishables for a minimum of 7 days maintained on the premises. Per staff, today is marketing day.

Per file review, Resident #1 does not have a physician's report with the results of a TB test on file. Resident #5 does not have a completed Physicians report with the residents primary and secondary diagnosis

Any deficiencies not addressed on this visit will be addressed on a return visit if needed.