Facility Evaluation Report

Licensing Program Analysts (LPAs) Salia Walker and Sandra Urena conducted a pre-licensing visit to this property at 01:02 p.m., and met with applicant representatives Arpine Mkrtchyan and Zhirayr Ayvazyan. The applicant has obtained fire clearance for a total capacity of five (5) non-ambulatory residents, and one (1) bedridden resident for a total capacity of six (6) clients. The STD 850 Fire Safety Inspection Request form did not specify which room was assigned as bedridden, nor was it indicated on the facility sketch provided.

LPAs inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. At 01:20 p.m., all hard-wired smoke alarms and carbon monoxide detectors were tested and function properly. LPAs observed one fire extinguisher to be fully charged with a purchase 04/23/2021.

There are three (3) double occupancy bedrooms for resident use. There is no-live in staff bedroom. Facility must have 24-hour wake staff. Each bedroom is equipped with clean mattresses, pillows and bedding. There is sufficient supply of linens, including blankets, bath towels and wash cloths. Bedrooms have sufficient lighting. The facility has three (3) bathrooms for resident use. Resident bathrooms contained appropriate non-skid mats and grab bars. Bathrooms have sufficient paper products. Night-lights were present in the main hallway. Hot water measured 119.3 Fahrenheit at 01:41 p.m.

LPAs toured the kitchen area at 01:07 p.m. The facility has a (7) day supply of non-perishable food. Appliances and all equipment appear to be clean and in good repair. Kitchen knives are stored in a locked cabinet. The kitchen has a sufficient supply of plates, cups, cook ware and utensils with range inaccessible for residents with Dementia. Hot water measured at 118.3 Fahrenheit at 04:04 p.m.The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. Enough seating for the residents, all six (6), to sit at the same dining. A working telephone is present. There are activity supplies or will be activity supplies.