Facility Evaluation Report

Licensing Program Analysts (LPAs) Leslie Ngo-Castaneda and Liezl De La Cerra conducted an annual required visit and inspection of the facility. LPAs was greeted by licensee, Grigor Kosoyan and was explained the reason for the visit.

At 11:00 AM, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms 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 entrance. The charge date is 8/31/2023. During the visit the facility is at 74 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; 1 bedridden; hospice waiver for 5.

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. The menu was posted for review. 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 laundry.

Bedrooms: There were four (4) bedrooms designated for residents' use. Bedroom #1 and bedroom #3 is vacant, bedroom #2 and bedroom #4 is is shared. Although bedroom #3 is vacant, the room has been used for staff storage. Deficiency will be cited on LIC 809-D. Resident bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting.

Bathrooms: There are two (2) bathroom at the facility, one for staff and the other one is designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 118.8 degrees Fahrenheit for bathroom #1 located in the hallway beside room #2. Continue to LIC 809-C