Facility Evaluation Report
Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and met with Sofia Ghazaryan, Administrator. The reason for today's visit was provided.
The facility is a single storey family home consisting of a living room, dining room, kitchen, 5 bedrooms of which one bedroom is used for live in staff, 2 common bathrooms and 1 staff bathroom. The facility is fire cleared for 4 AMBULATORY, 1 NON-AMBULATORY and 1 BEDRIDDEN resident. Bedroom #3 is approved for bedridden use.
Due to time constraints none of the domains were reviewed on today's visit. 3 resident files were reviewed.
Resident #1 does not have a signed medical consent form, has an incomplete Appraisal/Needs and services and inventory of valuables
Resident #2 has an incomplete Appraisal/Needs and Services
Resident #3 does not have a signed medical consent form and a incomplete Appraisal/Needs and Services.
The Licensee is the SSI payee for Resident #3 and the facility does not have a surety bond.
Due to time constraints, deficiencies observed on today's visit will be cited on a return visit.
Exit interview was conducted and a copy of this report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction