Facility Evaluation Report

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA was greeted by Anna Hakobyan who is the licensee and was explained the reason for the visit.

At 1:49 PM, with the assistance of licensee, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 2:45 PM the smoke alarms were tested are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the living room with a charge date of (date). During the visit the facility is at 74 degrees Fahrenheit. The facility is fire cleared for six (6) non-ambulatory residents, of which one (1) may be bedridden in bedroom #1; hospice waiver for six (6).

Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working electric stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the shed.

Bedrooms: There were four (4) bedrooms designated for residents' use. Bedroom #1 and bedroom #3 all private used for residents and empty. Bedroom #2 and bedroom #4 are shared. Bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting.