Facility Evaluation Report

Licensing Program Analyst (LPA) Lorena Casillas conducted the unannounced annual inspection. LPA met with Licensee/Administrator, Kristina Adamyan and explained the purpose of the visit. The facility is licensed for 6 non-ambulatory residents, of which 1 may be bedridden. Bedroom #3 is approved for bedridden. Facility has a hospice waiver approved for 5 residents.

LPA conducted a facility tour at 11:30 am with the Administrator and the following was observed:

Currently there are three (3) residents in the facility two (2) of which were present and one (1) was out in the community.

Infection Control: LPA reviewed facility infection control plan to make sure licensee was following current infection control recommendations. Infection control plan last updated on 05/01/2024.

Kitchen : LPA conducted a tour of the kitchen at 11:30 am and observed there to be sufficient stock of two-day perishable and seven-day non-perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. Medication and knives are stored in locked cabinets. First aid kit furnished and fully equipped.

Common Areas : LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 71°F. LPA observed staff and client files locked in the filing cabinet. The smoke detectors and carbon monoxide detectors were tested and observed to be operational. There is one (1) fire extinguishers located in the kitchen hallway. The fire extinguishers was observed to be full however it was last serviced on 03/15/2023. Administrator purchased and had a new fire extinguisher delivered during visit. Continued on LIC809-C