Facility Evaluation Report

On 12/21/2022 at 9:43 p.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above to conduct a Required Annual/Infection Control inspection. LPA was greeted by caregiver Tamara Ter Grigoryan who was wearing a mask and granted access. LPA asked Tamara to call administrator Lusine Meliksetyan but due to a language barrier Tamara did not understand what the LPA was requesting LPA called administrator Lusine and explained the reason for the visit. Lusine told LPA she will not be meeting us at the facility because she was in another city. Administrator designated caregiver Tamara Ter Grigoryan to sign for this report. LPA reviewed the Mitigation Plan approved 03/04/2021. The inspection tool was used to complete the visit.

At 9:53 a.m. LPA and caregiver Tamara began a physical plant tour of the facility and the following was observed:

Infection Control: Infection Control: LPA observed appropriate infection control signs posted in front of the door. Upon entry staff was wearing a mask. LPA observed appropriate infection control signs posted along the entry. Hand sanitizer, gloves and masks were observed available for use. Tamara took LPA's temperature and requested LPA to sign in. Tamara states the facility has enough PPE for 30 days. Kitchen: At 9:58 LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Knives are kept locked in a kitchen drawer inaccessible to residents. LPA observed a 2-day perishable and 7-day non-perishable supply of food. LPA observed caregiver preparing breakfast for residents. LPA observed a table with bar stool chairs by the kitchen that were clean and in good repair. Fire extinguisher by kitchen was fully charged and purchased 09/26/2022. Common Area: Common areas include one sitting area, one tv area and a dining area. All areas were well lit, clean and clear of clutter. Furniture was clean and in good repair. A fireplace in the dining area was adequately screened. Appropriate infection control signs were posted along a wall in the tv/dining area. (Continue on 809-C)