Facility Evaluation Report

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a continuation of the required annual visit at 10:16 AM. LPA met with the facility Administrator Naira Badalyan. Entrance interview was conducted and the reason for the visit was explained.

RECORD REVIEW: Record review began at 10:22 AM. 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. Five (5) resident files were reviewed. Two (2) resident admission agreements were observed to be missing the rate for basic services. Three (3) resident files for residents who were identified as having hearing loss were missing the required Telecommunications Device Notification form (LIC 9158). Two (2) incident reports were observed in resident files. LPA reviewed the facility’s file and did not observe incident reports for these incidents. LPA observed that the incident reports were sent within the required timeframe but were submitted to the incorrect fax number. This is considered a technical violation and no deficiency is being generated under this report. LPA provided the appropriate fax number to the Administrator who agreed to submit all future incident reports to the appropriate fax number. Five (5) staff files were reviewed. All staff files reviewed contained the required documentation and trainings.

MEDICATION REVIEW: Medication review began at 12:05 PM. Medications are stored centrally and securely in the Administrator’s office. Medications for three (3) residents were observed. All medications reviewed were properly stored and were properly documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. CONTINUED ON LIC 809C.