Facility Evaluation Report

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced Case Management inspection as the facility requested a capacity and hospice waiver increase from six (6) to twelve (12). The LPA arrived at 9:11AM and met with the Licensee Angela Krbashyan who arrived shortly thereafter. Entrance interview conducted.

Beginning at 9:24AM, the LPA and Licensee conducted a physical plant tour. The facility had nine (9) resident bedrooms: six (6) private bedrooms and three (3) shared bedrooms. The facility was approved for a total of twelve (12) bedridden residents. There was a total of eight (8) restrooms: seven (7) private resident restrooms and one (1) shared common area restroom located in the hallway. The LPA observed sufficient space inside the bedrooms and in the common areas to accommodate residents’ activities and the increase in capacity. There were three (3) outdoor areas: one (1) front yard, one (1) rear yard, and one (1) courtyard. The front and rear yard had entrances and exits for everyday use and in the event of an emergency. All passageways were free of obstruction. Fire extinguishers were observed throughout the facility and were fully charged and serviced or recently purchased.

Effective 12/18/2025, the facility was issued a new license reflecting the capacity and hospice waiver increase. The Licensee was provided a signed copy of their license in addition to the hospice waiver increase approval letter.

No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.