Pre-licensing visit·October 31, 2023

Licensing Program Analyst (LPA) Christine Yee conducted an announced Pre-licensing and Component III visit and met with Sargis Ayvazyan, Applicant and Marine Danielyan, Spouse/Staff. The facility is a single storey family home consisting of a living room, dining room, kitchen, 4 bedrooms of which one is used for live-in staff, a office, a laundry room, 2 full bathrooms and a attached garage. The facility is fire cleared for 3 NON-AMBULATORY and 3 BEDRIDDEN residents. Bedrooms #1, #2 and #4 are designated for bedridden residents. The home is also equipped with a sprinkler system. The following was observed on today's visit: the living room is furnished with a sofa and 2 armchairs. Located in the living room is a fire place. A fire screen was not observed. the dining room has a glass table with 6 chairs the kitchen is equipped with a stove, microwave and 3 refrigerator. Cleaning supplies are stored in a locked cabinet under the kitchen sink. Knives are stored in a locked kitchen drawer. 13 dinner plates, 3 salad plates, 9 bowls, 4 cups, 3 plastic glasses, pots, pans, 6 dinner forks, 6 desert forks, 6 dinner knives, 6 tablespoons and 6 teaspoons were observed. No perishable foods were purchased and additional non-perishable foods for 7days were purchase during the visit. The only fire extinguisher, purchased on 7/17/23 and the carbon monoxide detector are located in the kitchen. 2 first aid kits and a first aid manual were observed in the kitchen. Tweezers, scissors were observed but no thermometer adjacent to the kitchen is the laundry room with a washer and dryer. A linen closet with 18 bath towels, 18 hand towels and 18 face towel and extra fitted sheets were observed. the attached garage can be accessed through the laundry room. The garage needs to be cleaned out due to excessive items stored in the garage resident bedrooms #1, bedroom #2 and bedroom #4 all contain 2 twin beds, 2 night stands, 2 lamps, 1 shared dresser and a built in closet, except bedroom #4 has 2 walk in closets. No chairs were observed. The 3 rooms have doors that lead directly to the outside and were equipped with auditory devices. Ramps were also observed. Window dressings for privacy were observed. bedroom #3 will be used for a live-in staff and was not furnished. the two common bathrooms, one located in the front and one located in the back, are equipped with a open shower, a toilet and a sink. Grab bars were observed. The bathrooms did not have any non-skid mats. A shower chair was observed in the front bathroom. Water temperature was tested and the water in the back bathroom read 123.3 degrees Fahrenheit and the front bathroom read 121.8 degrees Fahrenheit. Thermostat was adjusted during the visit and retested at 4:15pm and it read 105 degrees Fahrenheit Medications will be centrally stored in a locked hallway closet the required posters were observed by the front door all exit doors to the outside are equipped with auditory devices resident and staff files will be stored in the office. 3 shampoo and 8 rolls of toilet paper were observed. Other hygiene products such as bath soap, toothpaste, toothbrushes, combs need to be purchased. the hardwired smoke detectors located in the resident rooms and hallway were tested and were operational cameras were observed in the common areas and in bedroom #3. Per applicant, the cameras are not operational and may be replaced. Applicant was advised to either remove or submit a written addendum to update the facility's plan of operation to indicate where the cameras are installed and how the information will be used and who has access to the information. 6 chairs were observed set up in the front of the facility the front yard, backyard and the sides of house need to be cleaned out and unused/discarded items and furniture need to be thrown out or stored away. The weeds and grass need to be removed/mowed. The hedge needs to be trimmed. the facility has a land line. Telephone # is (747) 225-2070 Applicant will obtain liability insurance in the required limits once the facility is licensed. The following corrections need to be addressed prior to licensure or as noted: a fire screen needs to be placed in front of the fire place a thermometer needs to be purchased for the first aid kit cups and glasses need to be purchased for 6 residents flat sheets, blankets and pillow cases needs to be provided and extra bed linens need to be purchased to allow for changing weekly and as needed. the garage needs to be cleaned out and all excess items due to construction need to be removed chairs for each resident need to be provided in all the resident bedrooms non-skid mats need to be provided in the bathrooms hygiene products and additional toilet paper need to be purchased perishable foods need to be purchased prior to the acceptance of the first resident. Liability insurance meeting Title 22 requirements will be purchased upon licensure the backyard, front yard and sides of the house need to be cleaned and items stored or discarded. a table for activities, chairs and an umbrellas provided for outside activity Applicant will provide evidence of the above corrections once it has been completed. COMPONENT III was conducted on today's visit with Sargis Ayvazyan and Marine Danielyan Exit interview was conducted.