Facility Evaluation Report

Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted by, identified themselves to and discussed the purpose of the visit with Administrator Charlz Partosan, Caregiver Brenalyn Partosan. The facility's license has a maximum capacity of six (6) residents, of whom all may be non-ambulatory and 6 may be bedridden with a hospice waiver for 6. This is a two story building but not approved for residents on the second floor.

LPA with Caregiver toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. The facility was clean, sanitary, and in good repair. Resident bedrooms contained the required furnishings. Doors, windows, screens, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Partosan, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with the Administrator to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.