Facility Evaluation Report

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA was greeted with staff Galina Nikolayevna and was advised for the reason of the visit. At 11:00 AM Karine Sarkisyan who is the licensee met with LPA, explained the reason for the visit.

At 11:58 AM, with the assistance of licensee, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 11:56 AM, the smoke alarms were tested and 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 kitchen. The charge date is 1.3.2026. During the visit the facility is at 70 degrees Fahrenheit. The facility is fire cleared maybe for two (02) non-ambulatory residents, five (5) ambulatory. Hospice waiver for six (6); one maybe bedridden bedroom #3.

Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas 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 kitchen below the sink. Office is located in the kitchen.

Bedrooms: There were three (3) bedrooms designated for residents' use. Bedroom #1, bedroom #2, and bedroom #3 are shared and is used for residents only, the bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting.