Facility Evaluation Report

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:16 AM. LPA met with facility staff who contacted the facility administrator Mary Petikyan via telephone call. Facility administrator arrived to the facility at 09:32 AM Entrance interview conducted and the reason for the visit was explained.

Beginning at 09:35 AM, the LPA, along with facility administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives as well as a secured cabinet located under the sink which contained cleaning supplies. The LPA observed fire extinguishers throughout the facility to be fully charged and purchased on 07/12/2024.

BEDROOMS : There are six (6) bedrooms in the facility; all six (6) are single occupancy and all are designated for resident use. LPA and facility administrator toured all six (6) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom number six (#6) is designated as the bedridden approved room and contains a direct exit to the front yard. One resident bed was observed to contain full bed rails. Auditory alarms were observed on facility exits and were functional at the time of the visit. LPA observed one (1) appropriately secured room, designated as a staff break room, to contain an extra refrigerator, an adequate supply of emergency water, and extra care supplies. Report Continued on LIC 809-C