Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was let into the home by Naira Aghajanyan, staff. Rebeka Durgaryan, Administrator was contacted by staff and she arrived at 10:44 *am to conduct the visit. The reason for today's visit was provided.

The home is a single storey family home consisting of 5 bedrooms, 3 full bathrooms, a living room, dining room, a den, office and a kitchen. The three back bedrooms are used by residents, the bedroom located by the front common bathroom is used for storage and the bedroom located by the front door is used as a staff room. The home has a fire place with the gas capped off and the fire grates dismantled. The facility is fire cleared for 1 BEDRIDDEN and 5 NON-AMBULATORY residents. Bedroom #2 is designated for Bedridden use.

On today's visit all 12 domains of the CARE Inspection Tool was reviewed, 6 resident and 6 staff files were reviewed and a tour of the entire facility, inside and outside was conducted and the following were observed:

the living room, dining room and kitchen all contained the required furnishings and appliances related to the designated use of the room.

sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed.

Bedroom #1 located to the left back of the facility was observed with 2 hospital beds, 2 chairs, 2 small dressers with 2 lamps and a closet that was missing its doors. No night stands were provided

The back den was observed with a sofa and a stand. The back door was opened and the auditory device was not operational

Bedroom #2 was observed with 2 hospital beds, 1 tall dresser, 2 night stands, 1 lamp, 2 portable closets and 2 chairs. Overhead lighting was observed and provided sufficient lighting. The exit