Pre-licensing visit·May 15, 2025

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility at 09:33 AM. The LPA met with applicant, Kristine Harutyunyan. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been requested for six (6) residents. The facility is one story. At 09:35 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for six (6) bedridden residents. The facility has one (1) private staff bedroom, Room #1, and three (3) shared resident rooms, Rooms #2, 3, and 4. Bedrooms #3 and 4 have direct exits to the outside. The facility is equipped with a fire sprinkler system. 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. All rooms were free of odors. Bedrooms #1 was observed to have a rip in the window screen and bedroom #2 was observed to be missing a window screen. There are two (2) bathrooms in the facility. Bathroom one (1) located next to the kitchen, is designated as a staff bathroom. The resident bathroom has a shower with non-skid materials. The toilet and shower 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 are stored in the Administrator’s desk which is currently located in the living room. Medications are centrally stored in a locked cabinet in the kitchen. The first aid supplies are stored in the entryway and were complete, including a thermometer and a current version of a first aid manual. Kitchen knives are stored in a locked drawer in the kitchen. Stove burners are rendered inaccessible to the residents by removing them when not in use. The supply of dishes, utensils, pots, pans and drinkware is adequate. LPA was unable to measure the temperature of the refrigerator or the freezer due to the absence of a temperature gauges. The supply of nonperishable and perishable 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. Kitchen, laundry and house cleaning supplies are stored in locked cabinets located under the kitchen and bathroom sinks. LPA observed the under-sink cabinet located in the staff bathroom to contain laundry chemicals and lack a locking device. 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 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 Stairway of the facility to lack a ramp for resident access which poses a potential hazard to residents with poor balance or eyesight. One (1) ramp, connected to bedrooms #3 and 4 was secure and non-slippery and was positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and were 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, fire doors, and carbon monoxide detectors were tested at 10:07 AM and functioned properly during the time of visit. Continued on LIC 809C. There are two (2) fire extinguishers throughout the house. They are fully charged and do not exceed the expiration date. Hot water was tested in each bathroom, which included the resident bathroom and staff bathroom, in addition to the kitchen; and, the hot water ranged from 117.0 to 118.6 degrees Fahrenheit. The laundry area is located in the staff bathroom. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in a hallway closet in addition to incontinence supplies. There is a functioning telephone on the premises. LPA did not observe emergency exiting plans/sketch posted in the facility. LPA did not observe emergency telephone numbers posted in the facility. Other required postings are posted in the living room and dining area. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the front of the house with tables and chairs where residents can sit. The entire property is fenced. An additional home with a separate address is separated from the facility by a fence and gate. The gate to the driveway is moved automatically. There is a gate for persons to enter the front yard. There is a locked storage shed in the back yard. There are not any bodies of water on the premises at the present time. The garage is not accessible from the house; the doors were not locked. LPA reminded the applicant that once they receive residents, if they store toxic or danger items or tools in the garage, it must be kept locked. COMP III orientation was completed with the applicant during this pre-licensing inspection. The following items 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. A follow-up inspection may be scheduled once all corrections are received to ensure compliance with regulation. 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. Continued on LIC 809C. 87303(c) 87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. 87555(b)(21) 87555 General Food Service Requirements (b) The following food service requirements shall apply: (21) Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. 87309(a) 87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 87307(d)(4) 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. 87212(c) 87212 Emergency Disaster Plan (c) Emergency exiting plans and telephone numbers shall be posted.