Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced Annual Inspection visit and used the CARE inspection Tool to conduct the visit. LPA Yee was let into the home by Ani Malkhasyan, Staff. Erna Gevorgyan, Administrator designee was conducted by telephone and she arrived at 11:06am to conduct the visit. The reason for today's visit was provided.

The facility is a single storey family home consisting of a living room, a dining room, a kitchen, 4 bedrooms, 2 private bathrooms and a common bathroom. Located in the back of the property is an ADU with a separate address - 6509 Bonner Avenue, and is not part of the facility operations. The facility is fire cleared for 1 AMBULATORY, 4 NON-AMBULATORY and 1 BEDRIDDEN resident. Bedroom #2 or Bedroom #3 approved for 1 bedridden use. The facility is approved for 6 hospice waivers.

On today's visit, the entire CARE Inspection tool was reviewed, 6 resident and 6 staff files were reviewed and the Emergency Disaster Preparedness Plan was reviewed. The following was observed:

Bedrooms #1 and Bedroom #2 are furnished with 2 beds, 2 night stands, 2 lamps, 2 chairs and a built in closet. No dressers were observed. The left bed in bedroom #2 was equipped with a full bed rail due to resident previously on hospice but has since being discharged and the right bed equipped with a half bed rail. Bed rails need to be removed. There is no physicians order for the use of the bed rails.

Bedroom #3 is furnished with 2 beds, 2 chairs, 2 lamps, 2 night stands, 1 built in closet and a shared dresser. The wall needs to be painted due to the resident peeling off the paint each time it is painted.