Medications: The facility has a locked medication cabinet and locked small refrigerator in the kitchen for resident medications.

Physical Plant: Facility is clean, sanitary, and in good repair. There is a main family/entertainment room, arts & crafts room, kitchen, laundry room, three bedrooms, two bathrooms, dining room, and two-car garage. Bedrooms #1, 2, and 3 have furniture to occupy two residents in each room. Bedroom #3 is missing a second chest of drawers/closet armoir. Staff will place a second armoir in the room, take a photo, and send it to LPA. Kitchen cleaning supplies are kept in a locked cabinet under the kitchen sink. Bathroom cleaning supplies are in locked cabinets under sinks. Laundry cleaning supplies are in a locked cabinet above washing machine and dryer. Walls, ceilings, floors, and areas inside the facility are clean, painted and/or in good repair.

There are three fire extinguishers, one located in the dining room hall near entryway, the second in the hall near bedrooms #2 & 3, and the third in the arts/crafts room. All three extinguishers are set in a box in the wall and are in the green zone with receipts showing they were purchased on 11/01/21. Combination smoke and carbon monoxide detectors (8) are located in the hallways, family room, arts & crafts room and bedrooms and were tested and working properly. Doors and passageways are unobstructed. Exterior doors and the door leading into the garage have delayed egress alarms that are in good working condition. The facility does not keep firearms or ammunition on the premises. Bathrooms are kept clean and in good repair. Water temperatures in bathroom #1 registered at 108.6 F degrees and 111.6 F in bathroom #2. The facility maintains a comfortable temperature of 73 F degrees.

Continued on 809-C.

A first-aid kit, kit manual and supplies are maintained in the kitchen. Refrigerator is maintained at 40 F degrees and the freezer was recorded at 0 F degrees. Food storage and preparation areas are clean and appropriate for food preparation. All appliances are clean and operating properly. Food utensils, dishes, and glasses are clean and in good repair. The facility has a minimum seven days of non-perishable foods. There are no knives accessible to residents. Knives are kept in a locked drawer in the kitchen. Kitchen water temperature was tested at 111 F degrees.

Resident and staff records are maintained at the facility in the kitchen hallway in a locked cabinet. Bathrooms and dining room drawers have a good supply of linens.

The exterior gate securing the backyard has a working self-latching lock and delayed egress alarm. The facility has a two-car garage with a numbered lock on the door between the house and garage and also the small door entering the garage from the backyard.

The facility has a 2019 Toyota Camry to transport residents.

COVID screening was conducted on LPA upon entry to the facility. The facility has a wall cutout at entry hallway with a thermometer and visitor sign-in sheet. The facility does not keep hand sanitizer in each room due to the fact memory care residents will reside in the facility. However, the facility does have plenty of hand soap and paper towels.

Items in underlined text are to be completed by 1/04/2022.

At 12:50 pm, exit interview was conducted with Lauren Mahakian, Vatche Khedesian, and Kristi Simonian, and a copy of the report emailed.