Facility Evaluation Report

The pre-licensing visit was conducted by Licensing Program Analyst (LPA), Sandra Urena. The LPA arrived

at the facility at 10:00 a.m., and met with applicant Vahe Mkrtchian. This is a new facility application for six residents. Fire Clearance was approved on 09/30/2022 for one bedridden resident, and resident is allowed to reside in either bedroom # 1,2,3, or 4.

At 10:25 a.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there

are no health and safety hazards, and facility is in compliance with Title 22 Regulations.

KITCHEN: A seven day supply of non-perishable food was available. The supply of dishes is adequate.

Appliances in the kitchen were clean and all appeared functional. Kitchen, and house cleaning supplies will be stored in locked cabinet in the hallway. Hot water temperature was recorded at 118.2 Fahrenheit degrees

Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area.

BEDROOMS: Facility has five (5) bedrooms. Four (4) bedrooms are for resident use, and one (1) bedroom for staff use. Bedrooms #2 and #3 are for double occupancy. Bedrooms #1, and #4 are private bedrooms. All bedrooms are approved for one (1) bedridden resident. Facility sketch describes bedroom #3 as the bedroom designated for the bedridden resident. Lighting in the rooms appeared adequate. All bedrooms had adequate closet and drawer space for clothing and personal belongings.

BATHROOMS: Two bathrooms are fully stocked with paper towels, and liquid hand soap. The showers have non-skid surface mats. Hot water temperature was recorded at 118.2 Fahrenheit degrees. Hand washing signs were visible and posted. Bathroom #1 and #2 are designated for residents, and staff use. They are fully equipped with handlebars and nonskid surfaces.