Facility Evaluation Report

Licensing Program Analyst (LPA) Abeye Duguma met with Gayane Agazaryan for a Required One (1) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 01:00p.m. and the following was noted:

The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water.

The facility is fire cleared for six (6) non-ambulatory, of which one (1) may be bedridden in Room #2, and a hospice waiver for five (5). The facility is currently occupying four (4) residents.

The living room and dining room are neat and clean. The facility has a total of four (4) bedrooms and two (2) bathrooms for residents. The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations.

Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. (continued on LIC 809-C)