Facility Evaluation Report

A Required One (1) year - Annual visit was conducted today by Licensing Program Analyst (LPA) Rosaura Valenzuela. LPA met with staff Gayane Khachatryan and explained the purpose of the visit. LPA observed that six (6) residents were at the facility during visit.

A tour of the physical plant was conducted at 12:30 PM and the following was noted:

The front main door is the only entrance being utilized at the facility. The facility is a single story home with four (6) private client bedrooms and three (3) bathrooms. There is no body water in the facility.

Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have ample supply of clean linen and towels.

Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature measured at a range of 105.6°F to 114.3°F and within the required range.

Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean and free of clutter during today's visit.

Living, dining & family room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition.

Kitchen area was observed to be clean and sanitary. All the toxins, cleaning solutions and disinfectants are locked in the cabinet below the kitchen sink. Knives and sharps are kept in the a locked storage located near the dining area.

Food . The facility is observed to have sufficient food supply for the clients both perishable and non-perishable.

Temperature of facility wall thermostat is set at 74.0°F and observed to be within the required range.

Fire extinguishers. The facility has three (3) fire extinguishers which were last bought on 01/25/22. Carbon monoxide and smoke alarms are hardwired and interconnected, tested and observed to be operable.