Facility Evaluation Report

Licensing Program Analyst (LPA) Abeye Duguma conducted an announced Pre-licensing visit at around 11:15 AM and met with the Licensee, Irena Raskopina . LPA conducted an entrance interview with the Licensee. LPA Duguma also observed that there were six (06) residents in the facility during the inspection. All residents appear to be clean and groomed.

With the assistance of the Licensee, LPA conducted a facility tour of both the inside and outside. This is a single-story property. Fire Clearance is approved for six (06) non-ambulatory of which one (01) may be bedridden. Facility has five (05) bedrooms and three (03) full bathrooms for residents. One (01) out of five (05) bedrooms is semi-private and the remaining are all private single occupancy. All residents’ bedrooms were adequately furnished. The facility has a designated staff room/office with its own bathroom. Facility also has a half bath for visitors near the front entrance. Resident bathrooms have properly installed grab bars and shower has non-skid mats. The average hot water temperature measured at 115.5ºF during the visit.

The common areas were appropriately furnished. The LPA observed entertainment equipment and games for activities. The staff office has a designated storage cabinet for resident and staff records. The first-aid kit is complete. The facility has adequate linen, water, and emergency kits. The linens were stored in the storage space located in the hallway.

The facility has working egress alarms on all exits. Smoke detectors and carbon monoxide detectors were checked and function properly. There is a fully charged fire extinguisher located between the kitchen and dining area.