Pre-licensing visit·May 5, 2021

Licensing Program Analyst (LPA) conducted a pre-licensing visit virtually through face-time with administrator Rima Agaronyan. This application is a change of ownership application. Facility currently has five residents. A tour of the physical plant was conducted. The facility has applied for a license to service elderly residents. The facility has a fire clearance for six non-ambulatory residents, one of which may be bedridden in room 2 or 4. The facility has four resident bedrooms two of which are intended for double occupancy (rooms 1 & 4). Rooms 2 & 4 designated for resident use have direct exits to the outside. All bedrooms were appropriately furnished. There is one bathroom designated for resident use. All rooms share a bathroom located in the hall. The bathroom has a shower with grab bars where appropriate. There are non-skid mats in the shower. The common areas were appropriately furnished and lighting was adequate. Resident and staff records will be stored in a locked closet in the entry area. Medications were stored in a locked cabinet in the kitchen. The first aid supplies are stored in the same cabinet as the medications. First aid kit is compliant with regulations at the time of the visit. Kitchen knives are stored in a secured drawer in the kitchen. Stove burners are functional. The supply of perishable and nonperishable food is adequate. The supply of dining and cook ware is adequate. Appliances in the kitchen were clean and functional. Kitchen and house cleaning supplies are stored in the laundry room. Laundry supplies are stored in the laundry room. The facility smoke alarm system is hard wired and functional. There is one fire extinguisher in the kitchen area. The fire extinguisher is fully charged. There is a functional carbon monoxide detector in the hallway. The smoke alarm is also a carbon monoxide detector. Hot water was tested; it measured at 115.0 degrees Fahrenheit. The laundry area is located in the hallway just outside Room #4. The supply of extra bed and bath linens is adequate. Personal hygiene items will be provided for residents. Extra incontinency supplies are stored in the hall closet. Telephone service for the facility is functional. Emergency exiting sketch is posted on the wall in the entry area. Required postings are posted in the entry area. The exterior passageways were free of obstructions. There is a patio area at the back of the house with furniture appropriate for outdoor use. The back of the property is fenced or walled. There is a gate on the side of the house that is unlocked and connects to the front yard. The front of the property is not fenced. Component III was conducted virtually also. No further action needed. LPA will forward copy of report to Cental Application Unit and they will notify applicant when facility is officially licensed.