Routine inspection·December 18, 2023

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted by, identified themselves to, and discussed the purpose of the visit to Caregiver Bebekyan. According to the facility’s license, the facility has a maximum capacity of six (6) residents all of whom can be non-ambulatory, and a waiver for four (4) residents on hospice. During today's inspection, there were a total of four (4) residents in care, of which one (1) received hospice care. This facility does not feature a secured perimeter or delayed egress doors. Required licensing postings were observed in visible areas of the facility. LPA, accompanied by Caregiver Bebekyan, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE) were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was compliant, at 73 F. The facility's hot water temperature for faucets used by residents measured at 112 F. There was no pool or large bodies of water on the premises. According to Caregiver Bebekyan, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility landline telephone were all working. Fire extinguisher was present. First aid kit and first aid manual were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and reviewed multiple staff and client records/files. The interviews did not raise any licensing concerns. The resident and staff files contained the required documents. Confidential records, medications, and toxins were inaccessible to residents in care. During today's visit, no deficiencies were observed. An exit interview was conducted with Caregiver Bebekyan, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.