Pre-licensing visit·March 28, 2024

Licensing Program Analyst (LPA) Emily Peraldi conducted a pre-licensing visit to the above noted facility. At 2:30 p.m., the LPA met with applicant, Liana Tandretsyan. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver for six (6) has been requested. At 2:34 p.m., a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory residents and one (1) bedridden resident. The facility is one story. The facility has four (4) resident bedrooms. Resident bedroom #3 has a direct exit to the outside. Bedridden resident is allowed in resident bedroom #3. All resident rooms are set up with beds, nightstands, lamps, chairs, chest of drawers and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed). Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms – ‘awake night staff only’ - is required. All rooms were free of odors. All window screens were clean and maintained in good repair. There are three (3) bathrooms in the facility, and the bathroom located inside the garage is designated for staff. The resident bathrooms has a shower with non-skid materials/ mats. The toilet and shower have grab bars. The hot water temperature was tested in the bathroom and the kitchen and was found to be within the range of 105*F and 120*F. Resident and staff records will be stored in a cabinet which is currently located near the kitchen in the laundry room. Medications will be centrally stored in locked kitchen cabinets. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored near the living area. Continued on LIC 809-C. Kitchen knives are stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area. Appliances in the kitchen were clean and all appeared functional. Trash cans are located inside a kitchen cabinet. Laundry and house cleaning supplies are stored inside the locked laundry room. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment, games and/or activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility had emergency food and water supplies. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. At 3:56 p.m., the smoke detector and carbon monoxide detectors were tested and functioned properly. The facility has a central entry point for symptom screening and temperature checks for staff and visitors. There is hand sanitizer available throughout the facility. There is a fire extinguisher near the kitchen area. It was fully charged and purchased on 02/03/2024. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in the laundry room. Extra incontinence supplies will be stored in the laundry room and in the hallway. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted throughout the facility. The emergency telephone numbers are posted near the entrance of the facility. Other required postings are also posted near the entrance of the facility. Continued on LIC 809-C. 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 property is gated. There are gates with a self-latching mechanism at the side of the house designated for an emergency exit. There are two (2) locked storage shed in the back yard. There are no bodies of water on the premises at the present time. The garage is not accessible from the house; the garage door was locked. The garage will be used for storage and remain inaccessible to residents. Component III was conducted in conjunction with this pre-licensing visit. No corrections required. Exit interview conducted. A copy of the report was issued. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB 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 CAB Analyst. Failure to comply could affect approval of your license.