Facility Evaluation Report

At 10:45 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual visit. LPA met with Lourdes Zapata, Caregiver, who granted access to the facility. The Administrator Marine Grigoryan was contacted via a telephone and LPA explained the reason for the visit. The Administrator arrived at the facility at 11:00 AM.

LPA was informed that the facility currently has six (6) residents, of which two (2) residents are non-ambulatory. Three (3) residents are currently on hospice. Facility has waiver for 4 hospice residents.

KITCHEN: LPA observed the kitchen area equipped with a refrigerator, microwave oven, and a sink. Stove was observed in a good working condition. At 11:10 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents in care. LPA observed a Fire Extinguisher and was purchased on 11/17/2025. It was observed hanging on the wall by the bathroom in the main hall.

MEDICATION ROOM: The centrally stored medication are kept in the in a locked cabinet in the main hall by the kitchen. Residents and staff files are also kept in a cabinet locked and inaccessible in the main hall by the kitchen. During review of 23's random medication revealed that the facility was supposed to start Carvedilol 12.5MG (Hypertension Medication) a new bottle on 10/16/2025. During today's visit LPA counted R2's medication and it was discovered that there was a discrepancy and twenty two (22) extra pills were in the bottle. LPA asked the Administrator and the staff for explaining and both staff and the Administrator could not provide any answers .