Facility Evaluation Report

Licensing Program Analyst (LPA), Salia Walker conducted a pre-licensing inspection to this property at 10:30 a.m. on January 19, 2022, and met with applicant representative Mary Petikyan. The applicant has obtained fire clearance for a total capacity of five (5) non-ambulatory residents, and one (1) bedridden resident for a total capacity of six (6) clients. Fire clearance indicates shared room ‘Bedroom #4 or for 1 bedridden patient.’

The LPA inspected the facility for Fire Safety, Personal Accommodations and Services, and Food Service. At 11:38 a.m., all hard- wired smoke alarms and carbon monoxide detectors were tested and function properly. The LPA observed two fire extinguishers to be fully charged with a purchase date of 08/18/21. There are two (2) single occupancy bedrooms, and two (2) double occupancy bedrooms for resident use. One (1) out of three (3) resident bedrooms have a private bathroom. There are no staff bedrooms in the facility. Each bedroom is equipped with clean mattresses, pillows and bedding. There is sufficient supply of linens, including blankets, bath towels and wash cloths. Bedrooms have sufficient lighting. The facility has two (2) common bathrooms for resident use. All common and private bathrooms contain appropriate non-skid mats and grab bars. Bathrooms have sufficient paper products, and hand washing signs. Night-lights were present in the main hallway. Between 10:43 a.m. and 10:53 a.m., hot water temperatures measured between 112.3 and 113.7 degrees Fahrenheit in the common and private bathroom(s).

The LPA toured the kitchen area at 10:54 a.m. The facility has a sufficient (7) day supply of non-perishable food, and will purchase perishable food upon admission of clients. Appliances and all equipment appear to be clean and in good repair. Kitchen knives are stored in a locked cabinet. The kitchen has a sufficient supply of plates, cups, cook ware and utensils. Hot water measured at 116.2 degrees Fahrenheit at 10:58 a.m.