Facility Evaluation Report

Licensing Program Analyst (LPA) Leizl de la Cerra conducted an annual required visit and inspection of the facility. At 10:30AM Armine Dishoyan met LPA at the entrance and LPA explained the reason for the visit.

Resident and Staff Records reviews and interviews: At approximately 11:00AM to 3:00PM, six (6) out six (6) resident records were reviewed. Ten (10) staff records were reviewed to ensure compliance.

Interview of two (2) staff was conducted. Interview of two (2) clients was conducted. Medications for two (2) residents were reviewed and appear to be given as prescribed.

At 3:00PM LPA with the assistance of the administrator took a tour of the facility.

Outside : LPA toured the outside area. LPA observed a shaded sitting area for residents. There is a locked detached storage/laundry room which is located outside. This storage room is where the two (2) washer and a dryer is located along with laundry chemicals. This room is also used for storing supplies such as toiletries, PPE supplies, incontinence supplies and wheelchairs. Additionally, there are two sheds with locks used also for storage. The facility does not have any bodies of water.

Common Area: LPA observed the living room and furniture to be clean and in good repair. The fireplace located in the living room is covered and inaccessible to residents. The facility maintains a comfortable temperature at 78 degrees Fahrenheit. The air conditioner is operational. The facility smoke alarm system is hard wired and interconnected. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. At 3:15PM they were tested and deemed operational. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed in the hallway. The fire extinguisher is in the kitchen with purchase date of 11/14/2023. The facility is fire cleared for five (05) non-ambulatory residents; one (1) maybe bedridden in bedroom #4 and approve for six (6) hospice waiver.