Facility Evaluation Report

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced One (1) year Required visit at this facility. LPA met with the administrator Iveta Darabedyan and explained the purpose of this visit.

A tour of the physical plant was conducted at 9:26 AM and the following was observed:

The facility has one main entrance being used. The PPE screening station is located immediately upon entrance and had a table equipped with sufficient PPE readily accessible, a thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit. The facility has an approved mitigation and infection control plan on file.

The facility is a single storey building and has five (5) bedrooms and three (3) bathrooms. An additional room is being used as an office and one (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, one (1) of which maybe bedridden on Room #5. Hospice waiver for six (6) residents.

Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 73°F. The dual smoke/carbon monoxide alarm are hardwired and interconnected and observed to be operational. There is a Fire extinguisher is located in the kitchen and observed to be full and current.

The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. (continued on LIC 809-C)