Facility Evaluation Report

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:14 AM. LPA met with facility staff who contacted the facility Administrator Mary Petikyan via telephone call. The facility Administrator arrived to the facility at 10:26 AM. Entrance interview conducted and the reason for the visit was explained.

Beginning at 10:26 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 : LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. LPA observed a secured drawer to contain knives as well as a secured cabinet located under the sink which contained cleaning supplies. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed the facility’s non-perishable food supply to contain four (4) cans of food that were approximately one (1) month past their expiration date and one (1) additional can that was dented. LPA informed the Administrator, who immediately removed the cans from the storage. Additionally, during the visit the Administrator conducted an audit of the facility’s food supplies to ensure no items near their expiration date were retained.

BEDROOMS : There are seven (7) bedrooms in the facility; six (6) are designated as single occupancy resident rooms and one (1) is designated as a staff room. LPA and facility Administrator toured all seven (7) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on facility exits and were functional at the time of the visit. LPA observed the staff bedroom to be properly secured. Additionally, the staff room contained an extra refrigerator, an adequate supply of emergency water, and extra care supplies. Report Continued on LIC 809-C