Pre-licensing visit·November 25, 2024

Licensing Program Analyst (LPA) Brian Balisi conducted a pre-licensing visit to the above noted facility.  The LPA met with applicant Andranik Kapikyan. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been requested. The current capacity is for six (6) clients, the facility doesn't have any clients at this time. The fire clearance was granted for  (6) bedridden clients. The facility is one story.  At approx. 11:05 am, a physical plant tour was conducted inside and out.  The facility has four (4)  private resident bedrooms.   Each bedroom  has a direct exit to the outside. There are fire sprinklers in the facility. There are no fire doors in the facility. All client rooms are set up with beds, nightstands, lamps, chests of drawers, chairs 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) and a bedspread. Lighting in the rooms appeared adequate.  In addition, no bedroom was used as a passageway to another room, bath or toilet.  There is no staff room at the facility. For NOC , there will be awake night staff only. All rooms were free of odors. All window screens were clean and maintained in good repair. There are three (3) bathrooms total. The resident bathroom(s) have a shower with non-skid materials.  The toilet and shower have grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Resident and staff records are to be stored inaccessible in the office area, which is currently located  next to the front entrance and only accessible from the exterior of the home. Medications are to be centrally stored in a locked hallway closet across from bedroom #1. Continued from 809 The first aid supplies were complete , including a thermometer and a current version of a first aid manual. First aid was observed stored inaccessible in the hallway closet as well. Kitchen knives are stored in accessible in a drawer to the right of the sink. Stove burners are rendered inaccessible to the residents by removing the knobs when not in use.  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 with utensils. Appliances in the kitchen were clean and all appeared functional at the time of the visit. Trash cans had tight fitting lids. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There is a television  in the living room. Entertainment equipment, games and/or activity supplies was observed on a shelf in the dining room. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to non private bathrooms.  There is no fireplace in the facility. There is a storage room located next to the front entrance. LPA observed it to be empty at this time. The facility has emergency exit signs . 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.  The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. Fire extinguishers were observed fully charged and serviced  in September 14,  2024. The laundry room is located at the garage entrance. Cleaning supplies and toxins were observed stored here and the room will be inaccessible to residents in care.  The garage is attached to the home and only accessible to staff.  LPA observed extra facility supplies emergency food supplies, extra non-perishable food, and facility equipment, tools and décor. Continued from 809 There is closet located in the main entrance that stored an adequate supply of extra bed and bath linens. Cabinets inside the bathroom #1 were observed to store personal hygiene items (shampoos, soaps) and other supplies for facility use. Cabinets are to be locked and inaccessible to residents in care.   There is a functioning telephone on the premises.  The emergency exiting plans/sketch are posted at the entrance, in the main hallway and in the bedrooms. The emergency telephone numbers are posted on the bulletin board near the front entry way. Other required postings are posted on the bulletin board as well. The exterior passageways were clean and clear of any obstructions.   There is a covered patio area in the rear of the home. LPA observed appropriate furniture for outdoor use. The outside area  was observed to be large enough to conduct outdoor activities. LPA observed a variety of fruit trees and a gardening area enclosed by a locked gate. The entire property is not fenced. There is no body of water observed at this time. Component III was conducted in conjunction with the visit. No corrections required  on a pre-licensing visit at this time. Exit interview conducted. Report issued and provided to Licensee. 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.