Facility Evaluation Report

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee was let into the facility by Anahit Anatomyan, Staff. Arpine Mkrtchyan, Administrator, was contacted via telephone and she arrived at 11:25am to conduct the visit. The reason for the visit was provided.

The facility is a single storey family home consisting of a living room, dining room, a kitchen, 3 resident bedrooms, 2.5 bathrooms, a den, a laundry room and a attached garage. The facility is fire cleared for 6 non-ambulatory residents.

On today's visit, all 12 domains, 4 resident and 5 staff files were reviewed. All 4 residents are receiving hospice services.

The following were observed on today's visit:

The dining room and living room have the appropriate furniture for 6 residents and was clean

The fire place located in the living room was observed with a metal fire screen.

The kitchen has the standard equipment - stove, refrigerator, toaster oven, coffee maker and dishwasher and was observed to be operational and clean. Knives are stored in a locked drawer.

sufficient perishable and non-perishable foods were observed in the kitchen and in the garage

Bedroom #1 and Bedroom #2 contained 2 hospital beds with full bed rails, 2 chairs,2 night stands, 2 lamps, a shared dresser, a shared closet and blinds for privacy. Located inside bedroom #1 is a private bathroom equipped with a shower stall, a toilet and a sink. Grab bars, a non-skid mat and a shower chair was observed. Water temperature was tested and read 116 degrees Fahrenheit. No window bars were observed in either bedroom.