Facility Evaluation Report

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced case management - deficiencies visit at the facility at 09:29 AM. LPA met with facility staff who contacted the facility Designee Hripsime “Ripa” Tavitian. The Designee arrived to the facility at 10:10 AM the reason for the visit was explained and entrance interview was conducted. LPA and the Designee contacted the Administrator Nona Ohanyan via telephone call. The Administrator was unable to come to the facility at the time of the inspection but has designated the designee to sign this report on their behalf.

During today’s visit LPA conducted a physical plant tour, reviewed five (5) resident files, and interviewed the Designee, one (1) staff and four (4) residents between 10:12 AM and 03:00 PM.

During file review LPA observed two (2) resident's admission agreements to be missing information. Both admission agreements were missing the rates residents were being charged for basic services. One (1) admission agreement was observed to be missing initials and signatures on all but the last page of the document.

LPA reviewed the facility personnel summary for all individuals associated and cleared to work for the facility. While reviewing this list LPA did not observe Staff #1 (S1) to be associated to the facility. S1 was observed to be working during the visit and was providing care and supervision to the residents. During an interview with S1 they revealed that they have worked for the facility for approximately 2 months. Continued on LIC 809C.