Facility Evaluation Report

On 11/6/2025, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival LPA was greeted by the Caregiver Champo Chilambwe , who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. The facility Administrator Mariam Balasanyan was contacted by phone and informed about the visit. LPA Khurshudyan reviewed the required postings on a wall throughout the facility. The inspection tool was used to complete today's visit.

At 10:25am LPA, with the help of the caregiver, began a physical plant tour of the facility and the following was observed: This is a single-story building with six (6) bedrooms, two (2) bathrooms, kitchen, common areas, and outdoor areas. This facility is operating as RCFE, has an approved fire clearance for six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility also has approved Hospice waiver for six (6) residents.

Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked kitchen cabinet. Emergency supply of food / water was stored inside the pantry. Food storage and preparation areas are clean and inaccessible to pests. LPA observed two (2) fire extinguishers in the facility, one (1) located in the hallway, and one (1) next to the kitchen area with a last service date 11/6/2025. A weekly menu was also available for clients and was posted on the fridge.

Bedrooms: There are six (6) bedrooms in the facility designated for residents’ use, the office is in the living area. All bedrooms are for private use. LPA observed bedrooms to be properly furnished with beds, linens, night stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean.