Facility Evaluation Report

Licensing Program Analyst (LPA) Sandra Urena conducted an announced Pre-licensing visit to the facility. LPA met with applicant Nona Ohanyan. Entrance interview conducted. This is a Change of Ownership(CHOW) application for six (6) residents. A Hospice Waiver for six (6) residents has been granted.

At 9:45 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.

Facility is a single-story residence, which consists of three (3) bedrooms and one (1) bathroom.

Fire Clearance was approved on 02/15/2024 for five (5) non ambulatory and one (1) bedridden resident to reside in bedroom #3. At the time of the visit, the LPA observed the facility sketch to be different than the one submitted to the Centralized Application Branch (CAB). Per the applicant an updated sketch approved by the fire department was emailed to CAB. However at the time LPA Urena received the pre-application packet, the original facility sketch was received with the packet. with the packet. The LPA will contact CAB about an updated facility sketch and a new approved fire clearance before completing the prelicencing visit.

Common Areas : These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Smoke detectors and Carbon Monoxide detector were tested and functioned properly during time of visit. Smoke detectors and Carbon monoxide detector are hard wired throughout the facility. Fire extinguisher was observed to be fully charged and purchased 12/11/2023. Facility accept dementia residents. The LPA observed signal alarms on exit doors.

Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of non-perishable food at the facility; properly stored. Sharp objects will be stored in a top kitchen cabinet. Medication will be locked in cabinet in the living room area. A laundry area with a washer and dryer was observed in a corner of the kitchen area.