Facility Evaluation Report

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. At 10:00 am Markui Kosayan who is the mother of the licensee met with LPA. At 10:24 AM Grigor Kosoyan who is the licensee arrived at the facility and met with the LPA and was explained the reason for the visit. A civil penalty will be issued since no staff was seen to be present when LPA arrived.

At 10:25 AM, with the assistance of licensee, 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 kitchen. The charge date is 11/30/2023. During the visit the facility is at 72 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 was kept unlock in the laundry. LIC 809-D will be cited on deficiency page.

Bedrooms: There were four (4) bedrooms designated for residents' use. Bedroom #1 is for private and vacant; bedroom #3 is for private use. Bedroom #4 is shared and vacant. Bedroom #2 is shared and is currently being only occupied by one resident. Resident bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting.