Pre-licensing visit·April 6, 2022

Licensing Program Analyst (LPA), Salia Walker conducted a pre-licensing inspection to this property at 8:30 a.m. on April 6, 2022, and met with applicant representative Rebeka Durgaryan. The applicant has obtained fire clearance for five (5) non-ambulatory residents, and one (1) bedridden resident for a total capacity of six (6) clients. Fire clearance indicates ‘Bedroom #1 allowed bedridden patient.’ The LPA inspected the facility for Fire Safety, Personal Accommodations and Services, and Food Service. At 9:24 a.m., all hard-wired smoke alarms and carbon monoxide detectors were tested and function properly. The LPA observed two (2) fire extinguishers to be fully charged with a purchase date of 05/05/2021. There are three (3) 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 one (1) common bathroom for resident use. All common and private bathrooms contain appropriate non-skid mats and grab bars. Bathrooms have sufficient paper products. Night-lights were present in the main hallway. Between 9:05 a.m. and 9:07 a.m., hot water temperatures measured between 109.5 and 116.9 degrees Fahrenheit in the common and private bathroom(s). The LPA toured the kitchen area at 8:58 a.m. The facility has a sufficient (7) day supply of perishable and non-perishable food. 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 112.8 degrees Fahrenheit at 9:34 a.m. Continue on LIC809C.. The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. The facility has enough seating to accommodate all residents. A working telephone is present. There are activity supplies stored in side tables/drawers in the living room. Medications will be stored and locked in a file cabinet located in the kitchen. First aid kit was observed to have bandages, thermometer, scissors, tweezers and a current first aid manual. Facility records will be stored and locked in file cabinet in the kitchen. Cleaning and disinfectants are stored and inaccessible away in utility room, and additional in the facility garage. Laundry area is located in the facility’s utility room next to the kitchen. Laundry detergents and personal hygiene items are stored in a locked cabinet located in the utility room. There is an adequate supply of emergency water, along with emergency nonperishable food items kept in the facility garage. There will be no firearms/ammunition stored on the property. The facility has required postings, including emergency exit plan, Licensing Complaint Poster, Resident Personal Rights, Theft and Loss Policy, and Resident Council Rights. Facility has one central entry point designated for universal screening. Alcohol-based hand sanitizer available upon entry. Signs are posted throughout the facility to promote handwashing, and cough/sneeze etiquette. Facility has an adequate 30-day supply of Personal Protection Equipment (PPE). The exterior passageways were clean and clear of any obstructions. There is one (1) body of water on the premises . At 8:55 a.m., the LPA observed the backyard, which has a covered outdoor area for resident use. There is (1) self-latching gate on the side of the house designated for an emergency exit. Physical plant is consistent with the submitted facility sketch/floor plan, but the administrator is waiting for their renewed administrators license at this time. During today’s visit, the LPA reviewed the facility’s program plan, personnel policies, abuse reporting procedures, in-service training protocol, and medication procedures. The facility’s Mitigation Plan Report was provided during the pre-licensing inspection. Continue on LIC809C.. Comp III conducted . This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating under the new facility license number, until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. The physical plant of this facility location is in compliance with Title 22 regulations at this time. Exit interview conducted. A copy of the report was provided.