Facility Evaluation Report

Licensing Program Analyst (LPA) Brian Balisi arrived to this facility today to conduct a One (1) year Required inspection of this facility with emphasis on infection control practices and procedures. LPA met with

Licensee Nino Gelashvili and Administrator Gohar Ambartsumyan and explained the reason for the visit.

At approx 09:15am, LPA toured the facility with Licensee and Administrator. Kitchen was observed to be inaccessible to residents at this time. The kitchen appeared to be clean at this time and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects were observed stored in the top drawer to the right of the stove. LPA observed drawer to be locked at this time. Cleaning supplies were observed to be kept locked under the sink. Laundry area was located next to the kitchen. LPA observed cabinets above washer and dryer to store PPE supplies. Cabinet to the right of the washer stored additional cleaning supplies and laundry detergent. LPA observed cabinet to be locked at this time. Dining room furniture appeared to be relatively clean and functional at this time.

At 9:30am, LPA observed Resident 1 (R1), residing in room #4. LPA observed Room #4 notated as a staff room per LIC 999 facility sketch. Licensee was advised to relocate resident to a room that has approved fire clearance for resident use. The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a sufficient supply of linen and personal hygiene supplies in the hallway closet nearest to the hallway bathroom.

LPA observed all bathrooms were clean, properly supplied and had functional fixtures. The hot water was measured in each bathroom between 112 - 117 degrees Fahrenheit at this time.