Facility Evaluation Report

Licensing Program Analyst (LPA) Shira Stamps met with Antuan Nazaryan (Licensee/Applicant) for a Pre-licensing inspection at 11:00 am. Entrance interview conducted.

The home will serve six (6) residents, and is fire cleared for five(5) non ambulatory and one (1) bedridden. The facility has three (3) bedrooms and two (2) bathrooms. Staff will be awake at night. The physical plant was toured inside and out at 11:15 am.

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 68 degrees F, which meet regulations. The air conditioner is operational. No firearms observed or will be maintained on the premises. Medications will be kept centrally stored and locked in a cabinet located in the living room.

The dual smoke alarm and carbon monoxide detector were operational and tested at 11:40 am. Fire extinguisher located in the kitchen appears to be full and was inspected during fire clearance inspection.

Resident room s: Two (2) rooms available will be shared. LPA observed rooms to have bedding sheets, pillowcase, blankets, mattress pads, which are in good condition. There is at least one chair, a nightstand, and sufficient lighting for each resident.

Window covering and window screens are in good repair for each room.

Residents will have sufficient amounts of supplies for personal hygiene products, which is provided by the Licensee.