Facility Evaluation Report

Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced continuation of the annual visit from July 11, 2024. At 11:00AM Jassman Geragossian, caregiver greeted LPA at the entrance and LPA explained the reason for the visit. Jassman contacted the administrator, Gayane Agazaryan by phone. After Jassman spoke with administrator, Jassman informed LPA that administrator will not be available, because the administrator is at the hospital due to a knee problem. The administrator was not available either on the previous visit for annual inspection on July 11, 2024.At 11:15AM, required records were requested.

Resident and Staff Records reviews: At approximately 11:45AM to 1:45PM, three (3) out three (3) resident records and four (4) staff records were reviewed to ensure compliance. Fire Clearance was approved on 01/17/2019 for five (5) non-ambulatory residents and one (1) bedridden in bedroom #2. All four (4) bedrooms are designated for resident use. Facility approved for five (5) hospice waivers. During staff records review LPA observed staff (S1) who was present at the facility giving care to residents, did not have a staff file. S1 did not have a fingerprint clearance and is not associated with the facility.

At 2:00PM LPA with the assistance of the caregiver, took a tour of the facility.

Common Area: LPA observed the living room and furniture to be clean and in good repair. The fireplace located in the living room is adequately closed and inaccessible to residents. The facility maintains a comfortable temperature at 76 degrees Fahrenheit. The air conditioner is operational. The facility smoke alarm system is hard wired and interconnected. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. At 2:15PM they were tested and deemed operational. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed in the hallway. Each exit features a functioning auditory alarm. There were two (2) fire extinguishers, one in the kitchen area and one in the common area, both inspected on 4/02/2024. The facility is fire cleared for six (06) non-ambulatory residents; one (1) maybe bedridden in bedroom #2 approve for four (4) hospice waiver.