Facility Evaluation Report

On 01/31/2023, Licensing Program Analyst (LPA), Sandra Urena, conducted a subsequent pre-licensing visit

at 10:00 a.m. The LPA met with the applicant, and conducted a follow up inspection to ensure that deficiencies were corrected prior to license being approved.

The first pre-licensing visit was conducted by Licensing Program Analyst (LPA), Sandra Urena. The LPA arrived at the facility at 09:40 a.m., and met with applicant Nelli Tadevosyan. This is a new facility application for a total of six residents, five (5) non-ambulatory, and one bedridden. Fire Clearance was approved on 11/18/2022 for one bedridden resident, and resident is allowed to reside in bedroom #3.

The following deficiencies were corrected:

During the inspection, the LPA, and applicant observed the following corrections.

1. Door leading to bedrooms is kept open.

2. An operating telephone is available for residents' use.

3. A gate was installed to prevent residents from wondering into the slopped area in the back of outdoor area.

4. The two protruding screws sticking out of the wall were covered, and a gate was installed.

5. A ramp for residents’ use was installed in the kitchen door leading to the backyard to allow access to residents to the outdoor area.

6. Trash cans with a tight-fitting lid were purchased and placed in the kitchen and all bathrooms.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst

when your license has been approved. You are not allowed to begin operating until you have been notified

that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your

Exit interview was conducted and reviewed with applicant Nelli Tadevosyan . A copy of the report was