Facility Evaluation Report

On 12/4/2024 an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the Caregiver Karina Kuliian, who granted access to the facility. LPA explained the reason for the visit. Shortly after the Administrator, Nina Kharatyan arrived and helped with physical plant tour and staff/residents files.

During today's visit, LPA conducted a physical plant walk through, at approximately 11:30am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22.

The facility is a single-story home and is licensed for capacity of six (6) residents, of which six (6) may be Non-Ambulatory and one (1) bedridden for bedroom #4. Facility also has a hospice waiver for five (5) resident. There are four (4) bedrooms in the facility of which four (4) are designated for residents’ use. All bedrooms observed to be appropriately furnished. All bedrooms have appropriate lighting. There are two (2) bathrooms in the facility designated for both residents’ and staff use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 12:45 to be 118°F. Extra towels and linens were readily available. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination.

LPA observed facility alarms were functional on all exit doors.

SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 1:00pm they were tested and observed to be operational. The facility has one (1) fire extinguisher that was last purchased on December 4th, 2024.