Routine inspection·December 14, 2023

On 12/14/2023 at 09:00 AM, Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced Required – Annual Continuation Inspection and met with Gayane Agazayan Administrator. Four (4) residents and two (3) staff were present during this inspection. Facility is following covid protocols. LPA Alemoh's temp was taken and asked to sign in upon entry. Facility has Facility is licensed to serve six (6) non-ambulatory residents, six (6) may be bedridden in any room. The facility also has an approved hospice waiver for six (6) residents. The facility currently has 2 non-ambulatory residents. The Annual Licensing Fees are current. The home consists of 1 floor level with: 2 staff room, 4 resident rooms, 3 restrooms, kitchen, dining room, and laundry room and isolation room. Facility Temp is 76 degrees Fahrenheit. At 01:40PM LPA began physical plant tour. LPA observed two fire extinguishers in the facility locked at ends of main hallway. Charge date is Nov 3rd, 2023. Facility also uses a sprinkler system; facility is also cleared for fire doors. The administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. LPA observed that Medications were safe, locked and inaccessible in the staff quarters. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 109.8-110.2F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two day supply of perishable and a seven day supply of non-perishable food. Knives and toxics were locked and secured in a drawer next to the sink. LPA observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days in the Pantry near the kitchen. First Aid kit and manual secured hanging on the wall behind the kitchen door. LPA tested all carbon monoxide detectors and smoke detector located in the kitchen area. Both devices were functional. LPA observed that all bedrooms and hallways are equipped with a carbon monoxide and smoke detector. At 02:40 PM LPA conducted a file review. All facility files are locked and stored in the Staff Room. 5 staff records were reviewed, 5 out of 5 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. 6 resident records were reviewed and, 6 out of 6 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. Last Fire Drill conducted 09/15/2023. An exit interview was conducted, Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Administrator Gayane Agazayan.