Facility Evaluation Report

Licensing Program Analyst (LPA) Evelin Rios arrived at the facility above to conduct an unannounced annual required visit. Mirna Daoud greeted LPA and granted access. LPA contacted the licensee Boris Adjamian and explained the reason for the visit. Licensee stated the facility has not admitted any residents and currently has a house sitter that will eventually be a caregiver when they admit residents. Inspection Tool not used for today's visit.

This facility is licensed as an Residential Care Facility for the Elderly (RCFE) with approved fire clearance for (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six (6) residents. LPA confirmed with licensee they are still interested in operating the RCFE and have paid their annual fee.

LPA conducted a physical plant tour of the facility. The facility overall was clean and clear of clutter. Plumbing fixtures and appliances were observed operable. LPA observed fire extinguishers through out the facility, fully charged with service date 02/19/2025. LPA observed the dual smoke and carbon monoxide detectors functioning properly.

LPA informed the licensee that residents bedrooms still did not have portable or permanent closets and drawer space but overall the bedrooms were clean and furnished with beds, mattresses, chairs and night stands. Bathrooms were equipped with grab bars and non slip mats. The laundry room was able to lock and leads to the backyard. The backyard and passageways were free of obstructions. No bodies of water observed.

LPA could not find administrator's or licensee's name on active or pending renewal administrator certification list. LPA advised to update CCL if they decide to cease operation.

No deficiencies observed during today's visit. Exit interview conducted. Licensee was unable to meet LPA for today's visit. LPA will email the report to the licensee and obtain their signature.