Facility Evaluation Report

Licensing Program Analyst (LPA) Abeye Duguma conducted an announced Pre-licensing visit at around 10:00 AM and met with the Licensee, Shikah Rathi. LPA conducted an entrance interview with the Licensee. LPA Duguma also observed that there were no residents during the inspection. All residents appear to be clean and groomed.

With the assistance of the Licensee, LPA conducted a facility tour of both the inside and outside. This is a single-story property. Fire Clearance is approved for six (06) non-ambulatory of which three (03) may be bedridden and a hospice waiver for one (01). Facility has five (05) bedrooms and two (02) full bathrooms. One (01) out of five (05) bedrooms is semi-private and the remaining are all private single occupancy. All residents’ bedrooms were adequately furnished. Resident bathrooms have properly installed grab bars and shower has non-skid mats. The average hot water temperature measured at 114.8ºF during the visit.

The common areas were appropriately furnished. The LPA observed entertainment equipment, reading material and games for activities. The has a designated storage cabinet for residents and staff records located near the kitchen and dining area. The first-aid kit is complete. The facility has adequate linen, water, and emergency kits. The linens were stored in the storage space located in the hallway.