Routine inspection·September 2, 2023

Licensing Program Analyst (LPA) Gary Tan, met administrator Daniel Alexandryan for a One (1) Year Required visit for this facility. The facility has no resident at this time and still under renovation. There was no person living at the facility at this time. LPA called the administrator and arrived about twenty (20) minutes later. LPA explained the reason for the visit. A tour of the physical plant was conducted at 10:20 AM and the following was noted: There is only one entrance being utilized at the facility, there is a required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The facility has a total of five (5) bedrooms and three (3) bathrooms. One bedroom is located in the converted garage that is designated for staff use.. Another bedroom is designated for staff use. One (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, (6) one (1) of which may be bedridden. Hospice waiver for six (6) residents. Living and dining room furniture were also checked. The smoke detectors are hardwired and interconnected and observed to be operational. There is a carbon monoxide installed at the facility. Fire extinguisher is located in the kitchen and observed to be full and current. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 809-C) (continued on LIC 809-C) There is no garage at the facility, only car port located at the front. The garage was converted into an office for staff use. It has access both outside and inside the house but it has lock for security purposes. Laundry area is located adjacent to the kitchen. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry area. Food Service/Kitchen the facility has no perishable food in stock as it has no resident and under renovation but has non-perishable food for seven (7) days in stock. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Linens and towels are sufficient in stock in the bedroom hallway cabinet. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. There is no water at the moment as it is undergoing renovation. Medications : The medication cabinet is located in the living room and has locking mechanism in it. There is a complete first aid kit located in the kitchen. Client records : There is no resident at the moment. Staff records : There is currently no staff at this time except for the administrator/licensee. Required posting observed in facility (complaint hot line poster). Exit interview conducted. Copy of this report issued.