Pre-licensing visit·June 18, 2025

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Susanna Mambreyan. This is a new facility. A dementia care program was included in the plan of operation. A Hospice Waiver has been requested. The facility is a one-story home. At 10:24 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory residents and, one (1) bedridden resident. The facility has three (3) shared resident rooms. Rooms # 2 and 3 have direct exits to the outside. Bedroom #3 is the bedridden approved room. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet There are no staff rooms, awake night staff is required. All rooms were free of odors. All window screens were clean and maintained in good repair. There are two (2) bathrooms in the hallway and one (1) private bathroom attached to bedroom #2. The resident bathrooms have a shower with non-skid materials. The toilets and showers have grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Continued on LIC 809C. Resident and staff records, along with resident medications, are stored in a cabinet which is currently located in the dining area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. Kitchen knives are stored in a locked box in the kitchen. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in the laundry room. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games and/or activity supplies in the living room and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. LPA observed the front entrance stairs to be missing appropriate hand railings. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There is a fireplace in the living room, it is screened and there are no tools. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There is one (1) of fire extinguisher throughout the house. It was fully charged and does not exceed the expiration date. Continued on LIC 809C. Hot water was tested in each bathroom, which included the resident bathrooms and any common bathrooms, in addition to the kitchen; and the hot water ranged from 110.7 to 117.1 degrees Fahrenheit. The laundry area is located adjacent to the kitchen. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in the hallway closet. Extra incontinence supplies are stored in the outdoor storage shed. There is a functioning telephone on the premises. The emergency exiting plans, emergency telephone, and other required postings are posted at the front entrance to the facility. The exterior passageways were clean and clear of any obstructions. There is a shaded patio area at the back of the house with tables and chairs where residents can sit. The entire property is fenced. The back and sides of the house are separated from the front yard by gates at the East and West side passageways. The gate to the driveway is moved automatically. There is a door w/gate for persons to enter the front yard. There are six (6) storage shed in the back yard. The backyard contains an additional structure associated with the property. There are not any bodies of water on the premises at the present time. COMP III orientation was completed with the applicant during this pre-licensing inspection. The following item must be corrected prior to licensure. Submit proof of corrections, along with a copy of this report, to LPA Byrne so that your application may be completed. This report will be sent to the Centralized Application Bureau (CAB) once all corrections are received. You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. 87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted.