Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit due to the deficiencies noted during a visit to the facility today. LPA Yee initially met with Marine Ashakyan, Staff but she had to leave due to a doctor appointment for a family member. The reminder of the visit was conducted with Mariam Baghdoyan, Staff. Asmik Nadrian, Administrator was not present at the facility since she has a full time job and is not available during business hours. The reason for today's visit was explained.

Per review of facility files, it was observed that Admission Agreements were missing signatures, basic rates for services, optional services, acknowledgement that a copy of the Personal Rights, Resident Council, Family Council and House Rules were provided.

Resident Files are incomplete - there are no signed medical consent forms, Telecommunications Notifications, no inventory list of personal belonging, Resident Rights, Incomplete Identification and Emergency information, no Health Screen with evidence of a TB test for Resident #1 and Resident #2

No PRN Authorization letters for the PRN medications for Resident #!

Administrator holds a full time job and is not available during business hours

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8

Exit interview was conducted, APPEALS RIGHTS discussed and a copy was given