Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was met by Ovsep Gasardzhyan, - Administrato r and explained the purpose of the visit. The facility is licensed to care for age range 60 and over, (4) ambulatory of which (4) may be non ambulatory. Facility has an approved hospice waiver for (4).

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Bathroom has hygiene items such as paper towel, hand soap and toilet paper.

Operational Requirements: A fire clearance is in place. Fire Drill has not been conducted with staff yet as there are (0) residents in the facility. Facility has working signal systems in exit points.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (4) resident bedrooms, (2) bathrooms, living room, kitchen, dining area, laundry area in the outside, backyard with shaded patio area and (3) small storage sheds. Currently, there are zero (0) residents in the facility. Detached garage was converted to an ADU and was permitted. ADU has a se parate entrance and address (633 Camino Real). The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. LPA observed miscellaneous items such as metal ramp railing and extra disassembled storage. Administrator agreed to clear the area. Backyard was inspected and has a shaded area and sitting area. There is a camera in the back yard. There is (1) fire extinguisher in the facility which was last serviced on 09/01/2023. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. At 9:50am, readings were 109.8 deg. F in bathroom #1 and 112.2 deg F in bathroom #2. *****REPORT CONTINUED ON LIC809-C*****