Facility Evaluation Report

Licensing Program Analyst (LPA) Brian Balisi conducted a Pre-licensing visit to the above facility. LPAs met with Administrator Anna Hayrapeteyn and explained the reason for the visit.

At 10:00am LPA toured the physical plant conducted physical plant along with Administrator. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. LPA observed Fire extinguishers to be purchased in July 2021. Smoke detectors and Carbon Monoxide detectors appeared to function properly during time of visit

Facility is a single-story residence and consists of a total of four (4) bedrooms and three (3) bathrooms. Fire clearance was approved on 7/20/2021 for four (4) non-ambulatory residents, one (1) ambulatory and one (1) bedridden. Fire extinguishers were observed to be fully charged from 6/07/2021. During physical plant tour LPAs observed the required postings throughout the facility.

Kitchen: The kitchen appeared to be clean at this time and the appliances and fixtures functional during the time of visit. LPAs observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects are stored in a cabinet in the kitchen to the right of the refrigerator. Medications are planned to be kept in this cabinet as well. No cleaning supplies or toxins will be kept under the sink. To the right of the kitchen was an empty room planned to be used for an office.