Facility Evaluation Report

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility at 10:48 a.m. to conduct a pre-licensing inspection. The LPA met with Applicant Rafael Matevosian. This is a Change of Ownership (CHOW) application from Matevosian Home (#197608025) to Matevosian Home (#195850290). The current capacity is for four (4) residents, the facility currently has four (4) residents. The fire clearance was granted on 09/09/2022 for ambulatory residents.

From 10:55 a.m. to 11:45 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: Kitchen knives are stored locked, and inaccessible to residents. The supply of perishable, and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were clean, and all appeared functional. There is an adequate supply of emergency food. The hot water temperature in the kitchen measured 108.2 degrees Fahrenheit. The fire extinguisher is mounted by dining room area, and was last serviced on May 1, 2022.

BEDROOMS: The facility has five (5) bedrooms, four bedrooms for residents, and one for staff. Bedrooms are single occupancy. All residents’ bedrooms are furnished appropriately with clean linens, furnishings, and sufficient lighting.