Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff#1 (S1) and explained the reason for the visit. LPA called Administrator LUSINE MELIKSETYAN who could not attend today's visit. Administrator Designee Ruzanna Manukyana came in her place arrived shortly after.

At 09:15 AM LPA took a tour of the physical plant. Required postings were observed in the entry area.

Kitchen : The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the office cabinets. The fire extinguisher is located in the kitchen with a purchase date of 03/23/26. Smoke alarms and carbon monoxide were tested and are functional.

Bedrooms : The facility has four (4) bedrooms of which two are shared room. All four (4) bedrooms were toured and appear to be clean and properly furnished. Bathrooms: There are two (2) bathrooms designated for residents' use. All bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 109.3 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection.

Common Areas : These included the living room and dining area. The common areas were properly furnished. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry room : was locked and inaccessible to residents. Garage : The garage was observed to be only used for storage. (Continue on 809 C)