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. Five (5) residents and two (2) staff were present during this inspection. Facility is licensed to serve six (6) non-ambulatory residents, five (5) may be bedridden in any room. The facility also has an approved hospice waiver for six (5) residents. The facility currently has 2 non-ambulatory residents. Residents are receiving Hospice services. The Annual Licensing Fees are current. The home consists of 1 floor level with: 1 staff room, 4 resident rooms, 2 restrooms, kitchen, dining room, and laundry room. 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. At 09:12 Staff began physical plant tour. 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. 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 106.2-107F. 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. First Aid kit was available stored in the garage. One fire extinguisher, last serviced July 23, 2024 was observed in the kitchen area. Second extinguisher located in the hallway charge date July 23, 2024. 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 10:45 AM LPA conducted a file review. 4 staff records were reviewed, 4 out of 4 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. 4 resident records were reviewed and, 4 out of 4 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. 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.