Facility Evaluation Report

At 10:00AM Licensing Program Analyst (LPA), Antonia Alvizar-Ettima conducted an announced Pre-Licensing visit to the above facility and met with Administrator, Nelli Berberyan. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL).

Fire Clearance was approved on 06/21/2024 for a maximum capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden in bedroom #5. Waiver/Granted for hospice care for six (6) residents. The purpose of today’s visit is to inspect the facility to ensure that the physical plant is in compliance with rules and regulations of California Code of Regulations, Title 22, Division 6, Chapter 8. The facility is a single-story building in a residential community. The facility has one new fire extinguishers that was purchased on April 15, 2024. The fire extinguisher is located at the enters of the facility.

A tour of the physical plant inside and outside was initiated at approximately 9:45am and the following was observed:

KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, sink and stove. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6) residents. All knives and sharps are observed to be locked in a cabinet in the kitchen and inaccessible to residents.

LAUNDRY ROOM: The laundry room is located outside the home. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use in a locked cabinet in the home.

BEDROOMS: There are five (5) bedrooms designated for residents to use. Bedroom #5 is a shared room, bedrooms #1 - #4 are private rooms. All resident bedrooms are furnished with bed, chair, nightstand, dresser and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational.