Facility Evaluation Report

At 9:30 AM Licensing Program Analysts (LPAs), Huma Rahimi and Nadia Shabazian, conducted an unannounced annual inspection at the facility mentioned above. LPAs met with the staff Anahit Zohrabyan and later Administrator Sofya Khechikyan arrived and explained the reason for the visit. Physical tour was conducted with the Administrator and LPAs observed the following:

The total capacity of the facility is approved for six (6) residents; however, LPAs observed seven (7) residents. LPAs were informed that one (1) of the residents is their family member.

Kitchen: At 9:45 AM LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen drawer. LPAs observed a fully charged fire extinguisher hanging on the wall by the kitchen purchased on 02/03/2025.

Medications: At 9:50 AM LPAs observed medications are centrally stored and locked closet in a hallway. Additionally, LPAs observed Hydrocortisone Ointment 2.5% in the kitchen drawer unlocked and as well as other medication and ointments in residents bedrooms unlocked and accessible to residents in care. Furthermore, at 2:30 PM, during the medication review for six (6) out of six (6) residents, LPAs could not verify the accuracy of the medication administration due to the lack of incomplete Centrally Stored Medication Destruction Form. Administrator informed LPAs that the Administrator did not complete the form and was unable to provide a reason.

Bedrooms: The facility has six (6) bedrooms in total. All bedrooms were clean and odorless. Furniture was in good repair. Bedroom #3 was designated for a bedridden resident, and the emergency exit was free from obstruction. Bedroom #6 is shared and one of the resident is a family member of the Administrator who requires full assistance with daily living. One of the bedrooms located near the kitchen is designated for staff and LPAs observed free of hazard and obstruction. LPAs also observed medication accessible to residents in their bedrooms. Continue on LIC 809C