Facility Evaluation Report

Licensing Program Analyst (LPA) Sandra Urena conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Knarik Davtyan. This is an application for a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been requested.

At 10:15 a.m., the LPA and the applicant conducted a physical plant tour inside and out to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a one-story dwelling. An approved fire clearance was received on 07/14/2023, clearing them for five (5) non-ambulatory residents; and one (1) of bedridden resident.

KITCHEN: Kitchen knives are stored in a locked cabinet in the kitchen. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at below zero degrees Fahrenheit (0*F) and the refrigerator was maintained at thirty degrees Fahrenheit (30*F) The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored and locked in a top kitchen cabinet and the garage area. No flies or other vermin were observed.

BEDROOMS: The facility has two (2) private residents’ bedrooms, Rooms # 1 and 4; and two (2) shared room(s), Room # 2 and 3. One residents’ bedroom, Room # 1 has a direct exit to the outside. The bedroom’s sliding door needs to be flushed with the floor for easy transfer from bedroom to outdoor area. Private bedroom # 1 has been approved and cleared for one bedridden resident. Bedroom #1 did not have a bed. Shared bedroom # two (2) did not have two beds. Private bedroom #3 has one bed. Shared bedroom #4, has one bed; needs one more bed. All bedrooms were set up nightstands, lamps, chairs and closet space. Continues on LIC 809C...