Pre-licensing visit·August 14, 2025

Licensing Program Analyst (LPA) Abeye Duguma conducted an announced Pre-licensing visit at around 10:00 AM and met with administrator, Abraham Joseph. This is a change of ownership application from Affectionate Care Home (LIC197609968) to Averie Manor (LIC197610707). LPA conducted an entrance interview with the Administrator. At the time of this visit LPA observed two (02) additional individuals working in the facility. LPA also observed and assessed five (05) residents present in the facility. All residents appear to be clean and well groomed. With the assistance of the Administrator, LPA conducted a facility tour of both the inside and outside. The facility was inspected for Fire Safety, Personal Accommodations and Services, Medication Procedures and Food Service. This is a single-story property. Fire Clearance is approved for six (06) non-ambulatory of which one (01) may be bedridden in Room #1. Two (02) in Room #2, two (02) in Room #3, one (01) in Room #4 and Room #5 is for staff only. Facility has a total of four (04) bedrooms for residents and two (02) bathrooms . Resident bathroom has properly installed grab bars and shower has non-skid mats. Hot water temperature measured at 115.3ºF during the visit. All residents’ bedrooms were adequately furnished. The linens were stored in the storage space located in the hallway. Towels and washcloths are not shared. The common areas were appropriately furnished and had adequate furniture. The LPA observed entertainment equipment and games for activities. The resident and staff records were stored in a closet located in the hallway with medication. The first-aid kit is complete. The facility has adequate linen, water, perishable and nonperishable food supplies. LPA observed a fireplace with the appropriate screen. (CONT. on LIC9099-C) LPA inspected the kitchen and observed the stove and refrigerator to be clean and working. Facility has at least two (02) days perishable and seven (07) days non-perishable foods. Nonperishable food was stored in the kitchen pantry. Sharps are stored in a locked kitchen drawer. The facility has working alarms on all exits. Smoke detectors and Carbon Monoxide detectors were checked and function properly. Fire extinguisher located in the kitchen, observed to be fully charged and last inspected 12/10/2024. LPA Duguma observed a washer and dryer in the garage adjacent to the kitchen. All chemicals, additional personal hygiene items were stored in a vertical locked storage. There is sufficient outdoor space with seating and a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. At the time of this visit the physical plant is meeting Title 22 requirements. The Component III completed with LPA. No health and safety hazard were noted during this visit. Exit interview was conducted and a copy of report was issued.