Facility Evaluation Report

LIcensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection and used the CARE Inspection Tool to conduct the visit. LPA Yee was let into the home by Lilliana Faure, Staff. Also present was Renier Zapanta, Staff. LPA Yee contacted Vahe Mkrtchian via telephone and he arrived a little later to conduct the visit. 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 is used for live-in staff, 2 common bathrooms and a attached garage. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN resident. Bedrooms #1 - Bedroom #4 may be used for the one bedridden resident. The facility has been approved for 6 hospice waivers.

On today's visit, the entire CARE Inspection Tool was reviewed, Resident and Staff files were reviewed and a tour of the physical plant, inside and outside was conducted and the following were observed:

Bedroom #1 and Bedroom #4 are private rooms and were furnished with one bed, chair, night stand, one lamp, one dresser and a built in closet

Bedroom #2 and Bedroom #3 are shared rooms and were furnished with two beds, two chairs, one night stand, one lamp, a built in closet. Sufficient lighting was observed from the overhead lights.

The required bed linens were observed on the beds, in the linen closet and in the garage.

Towels were observed in the bedrooms and in the garage.

All the facility windows were observed with blinds for privacy.