Facility Evaluation Report

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit at 10:10 a.m. and met with the Administrator and applicant Harut Sargsian. This is a new facility application for an Adult Residential Facility (ARF) four (4) non-ambulatory residents, which one can be a bedridden resident. Fire Clearance was approved on 12/14/2023 for one bedridden resident in bedroom #2.

At 10:20 a.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Kitchen knives are stored locked and inaccessible in the pantry cabinet. A seven-day supply of non-perishable food was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 115.0 degrees Fahrenheit. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. A fire extinguisher is located near the backdoor exit, which was purchased on 01/24/2024.

BEDROOMS: There are (4) bedrooms for residents in care. Room 1 will be a shared room; applicant will email a new sketch to the Community Care Licensing office to reflect the changes to the rooms’ designations. Bedrooms #2 and #3 are designated as private rooms. Room #2 was approved by the fire department as the bedridden bedroom. All other bedrooms are cleared for non-ambulatory. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available.