Facility Evaluation Report

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 11:28 AM. LPA contacted the facility Administrator Knarik Davtyan. The Administrator stated that they were unable to come to the facility at the time of the visit but stated that Staff #1 (S1) could conduct the annual visit with LPA. The Administrator advised LPA that the facility does not currently have residents.

Beginning at 12:02 PM, the LPA along with S1 toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN : The kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured cabinet to contain knives and other sharp objects. LPA observed an additional secured cabinet designated to store resident medications.

COMMON AREAS : This includes the living room and entry area. LPA observed the living room to be clean and properly furnished. Auditory alarms on the exit door to the backyard were disabled at the time of the visit. The living room was observed to contain activities for resident use. The entryway was observed to be clean and contained all requires postings. The entryway contains an appropriately screened fireplace and adequate seating. LPA observed the facility hallway to contain a pantry that contained adequate emergency food supplies. The LPA observed two hallway closets to contain extra linens and space for resident storage. LPA observed the fire extinguisher to be fully charged and was serviced on 10/01/2024. Combination smoke and carbon monoxide detectors were tested at 12:22 PM and all were functional at the time of the visit. No fire clearance concerns were observed. Continued on LIC 809C.