Facility Evaluation Report

At 10:00 a.m Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct an announced Pre-licensing inspection. Upon arrival LPA met with administrator Azniv Ter-Arsenyan. The facility will be licensed as a Residential Care Facility for the Elderly. Facility is a single-story house with six (6) bedrooms and two (2) bathrooms. Facility has been approved for a capacity for six (6) residents in which five (5) may be non-ambulatory and one (1) bedridden. Hospice waiver has been approved for six (6) residents.

The physical plant was toured inside and out at 10:05 a.m

Common Area: LPA observed the living room and furniture to be clean and in good repair. LPA observed the dining area to be clean and in good repair. The facility maintains a comfortable temperature at 72 degrees F, which meet regulations. The air conditioner is operational. No firearms observed or will be maintained on the premises. The smoke alarm and carbon monoxide detector were operational and tested at 10:16 a.m. Facility has a fire door that is activated when the fire alarm is triggered. Door was observed to be operational. The fire extinguisher was observed to be full with a purchase date of 05/03/22. Facility maintains a telephone landline that was tested and observed to be operational.

Kitchen Area: LPA observed the kitchen area to be in good repair and sanitary. A start up amount of perishable and non-perishable foods were observed. Sharps were observed to be locked and inaccessible to residents. Trash can contain a tight fitting lid.

Bedrooms: Facility has six (6) bedrooms in which all will be single use. Bedroom number one (1) will be designated for bedridden resident. All of the other rooms have been approved for non-ambulatory residents. All bedrooms were toured and were observed with the appropriate furniture and bedding. Lighting in hallway will be dimmed during the nighttime to provide light to residents accessing the hallway. There is a small staff room located in the hallway that will be used for an office space. Medications and files will be kept in a locked cabinet located in the hallway.