Facility Evaluation Report

At 10:00AM Licensing Program Analyst (LPA), Antonia Alvizar conducted an announced Pre-Licensing visit to the above facility and met with Applicant/Licensee, Nvard Gevorkian.

Fire Clearance was approved on 07/10/2023 for a maximum capacity of six (6) residents, of which three (3) Non-Ambulatory and three (3) Bedridden residents. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. At 10:20AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents. New Fire Extinguishers were dated 07/07/23.

LAUNDRY ROOM: The laundry room is located next to the kitchen divided with a locked door. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision.

BEDROOMS: There are five (5) bedrooms designated for client use. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational.

BATHROOMS: At 10:35AM LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat. Water temperature was within regulation.