Facility Evaluation Report

Licensing Program Analyst (LPA) Quoc Huynh conducted a conducted an unannounced visit at the facility in conjunction to an investigation of complaint control 29-AS-20240501152453. LPA arrived at 10:54AM and met with Staff Armine Melkonyan (S1), who spoke little to no English. LPA spoke with Licensee Anna Atayan at 10:57AM via telephone call and explained the reason for the visit. The Licensee arrived at 11:25AM. Entrance interview conducted

During today’s visit, LPA Huynh and the Licensee conducted a tour of the physical plant areas at 11:26AM to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. LPA observed Resident #1 (R1) was bedridden and residing in Bedroom #1. The facility is cleared for bedridden residents to reside in either Bedrooms #4 or #5, with only one (1) bedridden resident at a time.

At 12:27PM, LPA reviewed resident files and obtained copies of two (2) residents’ physician reports and appraisal.

Pursuant to Title 22 of the CA Code of Regulations and/or Health and Safety Code, the following deficiency was cited. (Refer to LIC 809-D).

An immediate civil penalty of $500 for a violation of the facility’s fire clearance was issued (Refer to LIC 412M). The Licensee understands that continued violation of the facility’s fire clearance may result in additional civil penalties.

Exit interview conducted. A copy of the appeal rights and report was reviewed and issued.