Facility Evaluation Report

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a continuation of the required annual visit at 01:34 PM. LPA met with facility staff who contacted the Licensee Representative Alvard Yervandyan and the facility Administrator Selva Banos via telephone call. The Licensee Representative arrived to the facility at 02:02 PM Entrance interview conducted and the reason for the visit was explained. The Administrator later arrived at 02:19 PM.

RECORD REVIEW: Record review began at 02:04 PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Six (6) staff files were reviewed. All staff files contained all required documents and trainings. Four (4) resident files were reviewed. All resident files contained all required documentation and signatures. No deficiencies were observed during record review.

MEDICATION REVIEW / CASH RESOURCE REVIEW: Cash resource review began at 03:01 PM. Cash resources were reviewed for four (4) of four (4) residents. All cash resources reviewed were documented and stored appropriately with corresponding receipts. No deficiencies were observed during cash resource review. Medication review began at approximately 03:05 PM. Medications are stored centrally and securely in a locked closet in the hallway. Medications for three (3) residents were observed. All medications reviewed were documented properly on their centrally stored medication and destruction record sheet. No deficiencies were observed during medication review.

During today’s visit LPA obtained a copy of the facility’s updated LIC500, surety bond, client roster, and liability insurance. No deficiencies were observed during today’s inspection. Exit interview conducted and copy of the report was issued.