Facility Evaluation Report

Licensing Program Analyst (LPA) Sandra Urena conducted a follow up Pre-licensing visit to the facility. LPA met with applicant Nona Ohanyan. Entrance interview conducted. This is a Change of Ownership(CHOW) application for five (5) residents. A Hospice Waiver for five (5) residents has been granted. 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.

On 05/23/2024, LPA Urena conducted an initial visit, and corrections were needed during the visit.

Administrator agreed to do the following corrections.

· Change bed from room #2 to room #3, which is the approved room for a bedridden resident. -Corrected

· Reorganize closest for rooms # 1 and 2.-Corrected

· Cell phone specifically for residents’ use.-Corrected

· Gardening supplies will be cleared and locked in the shed.- Corrected

· Facility sketch will be updated to reflect the approved fire department sketch.-Corrected

This report will be sent to the Centralized Application Unit (CAB) once all corrections are received. You will be notified by the CAU Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview was conducted and a copy of the report was issued.