Facility Evaluation Report

On 12/14/2023 at 09:00 AM, Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced Required – Annual Continuation Inspection and met with Gayane Agazayan Administrator. Four (4) residents and two (3) staff were present during this inspection. Facility is following covid protocols. LPA Alemoh's temp was taken and asked to sign in upon entry. Facility has

Facility is licensed to serve six (6) non-ambulatory residents, six (6) may be bedridden in any room. The facility also has an approved hospice waiver for six (6) residents. The facility currently has 2 non-ambulatory residents. The Annual Licensing Fees are current.

The home consists of 1 floor level with: 2 staff room, 4 resident rooms, 3 restrooms, kitchen, dining room, and laundry room and isolation room.

At 01:40PM LPA began physical plant tour.

LPA observed two fire extinguishers in the facility locked at ends of main hallway. Charge date is Nov 3rd, 2023. Facility also uses a sprinkler system; facility is also cleared for fire doors.

The administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises.

LPA observed that Medications were safe, locked and inaccessible in the staff quarters. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law.