Pre-licensing visit·December 7, 2016

The prelicensing visit was conducted by LPA Aja Richardson The LPA met with applicant Narine Hannesyan. This is a new facility . The physical plant was toured inside and out. The facility has been cleared for 6 nonambulatory residents which one may be bedridden. The facility has two private resident bedrooms and two shared resident rooms. Rooms 3 and 4 have direct exits to the outside. Rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. Lighting in the rooms appeared adequate. The office is a designated staff room. There is one bathroom in the hallway and one bathroom in room number two. The resident bathrooms have a shower with non-skid materials. The toilet and showers have grab bars. The common areas were appropriately furnished and the lighting was adequate. Resident and staff records are stored in a filing cabinet which is currently located in the staff room. Medications are currently stored in a locked cabinet in the kitchen. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in kitchen cabinet. 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 nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in the kitchen. There is a fireplace in the living room. It is screened and there are no tools. The facility smoke alarms and carbon monoxide alarms were tested and working. There is one fire extinguisher in the home and it is charged. Hot water was tested in the resident bathroom; it measured 107.8 degrees Fahrenheit. The laundry area is located outside in the backyard in a storage shed. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) are stored in kitchen cabinet. Extra incontinency supplies are stored in hallway closet. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted in hallway. Emergency telephone numbers are posted in the hallway. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. The entire property is fenced . The back and side of the house is separated from the front yard by a gate. There is a door w/gate with a self-latching mechanism for persons to enter the front yard. There is a locked storage shed in the back yard. There is a pool in the back yard that is surrounded by a locked fence. The garage is not accessible from the house; the doors were locked. The garage has been converted a staff room/storage. The following items are needed for the facility to comply with Title 22 Regulations. 1) Television in living room/dining area 2) Alarm on kitchen exit door 3) Washer and dryer Please provide proof that all the above listed items have been completed to your Centralized Applications Unit (CAU) Analyst with-in 10 working days. This report will be sent to the Centralized Application Unit (CAU). You will be notified by the CAU 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 CAU Analyst. Failure to comply could affect approval of your license. Exit interview held and report issued.