Facility Evaluation Report

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with licensee, Anna Sargysyan, and was explained the reason for the visit.

At 8:49 AM, with the assistance of licensee, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 11:08 AM, the smoke alarms were tested and they are operational, alarms are located in 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 4.22.2026. During the visit the facility is at 76 degrees Fahrenheit. The facility is fire cleared for three (03) non-ambulatory residents. One (1) bedridden in bedroom 2 or 3. Ambulatory only in bedroom #1, 4 or 5. Hospice waiver for six (6).

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 cabinet below the sink.

Bedrooms: There were five (5) bedrooms designated for residents' use. Bedroom #1, and bedroom #5 are private. Bedroom #2 (single occupant) and bedroom #4 are shared. Bedroom #3 is vacant. Continue to LIC 809-C