Facility Evaluation Report

On 12/16/2025 at 09:30 am Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility for an unannounced one (1) year required visit. LPA was greeted and granted access by a staff member. LPA met with Licensee, Arlen Shahverdian. LPA informed Licensee of the purpose of the visit, entrance interview conducted.

A fire clearance was approved on 8/20/2024, for four (4) non-ambulatory residents and two (2) ambulatory residents for a total capacity of six (6). The facility has four (4) bedrooms, three (3) of which are shared and for resident use. Currently the facility is occupied by six (6) residents.

INFECTION CONTROL and EMERGENCY PREPAREDNESS PLAN: LPA reviewed facility Infection Control Plan and Emergency Preparedness Plan to make sure facility is following protocols.

A tour of the physical plant was initiated at 10:30 am and the following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There is an adequate supply of two (2) day perishable and seven (7) day nonperishable foods. LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Cleaning solutions are locked under the sink. Knives are kept locked in a kitchen cabinet inaccessible to residents.