Facility Evaluation Report

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

at the facility at 10:50 a.m., and met with applicant Hrachia Martirosian. This is a new facility application for a total of six residents, five (5) non-ambulatory, and one (1) bedridden. Fire Clearance was approved on 09/16/2022 for one bedridden resident, and resident is allowed to reside in either bedroom #1 or # 2.

At 11:00 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 that the 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. House cleaning supplies will be stored in a locked cabinet under the sink. Hot water temperature was recorded at 108.8 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 for resident use. There is no bedroom available for staff use. Bedrooms 2, 3, 4 and 5 are for single occupancy. Bedroom #1 is designated as a shared bedroom. Either bedroom #1, or #2 are approved for one (1) bedridden resident. Lighting in the rooms appeared adequate. All bedrooms had adequate closet and drawer space for clothing, and personal belongings. Bedrooms’ doors # 1, and 2 will need to be leveled to ensure safe passage for residents to the outdoor area. Hallway exit door needs to be leveled to ensure safe passage to the outdoors. Bedroom #2 has a three shelf apparatus with sound equipment that partially obstructs the passageway for exit. Additionally, a drainage pipe is sticking out at the bottom of the wall facing the bathroom. Bedrooms # 3, 4, and 5 need a bed, mattress, pillows and bedding/linens. Bedroom #1 is missing pillows, and bedding linens