Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the CARE Inspection Tool and was let into the home by Eleanora Gabrielyan, Staff. Staff contacted Nelli Sadoyan, Administrator, by telephone and she arrived to conduct the visit at 10:27am. The reason for today's visit was provided.

The facility is a single storey family home consisting of a living room, dining room, kitchen, 3 resident bedrooms, an office, 2.5 bathrooms and a detached garage. The facility is fire cleared for 2 AMBULATORY, 2 NON-AMBULATORY and 1 BEDRIDDEN resident. The facility has an approved hospice waiver for 5.

On today's visit, all 12 domains of the CARE Inspection Tool, 5 resident files and 3 staff files were reviewed. A tour of the entire facility, inside and outside, was conducted. The following was observed:

the living room, dining room and kitchen were all furnished and equipped with the appropriate furniture and equipment for its designated use. The fire place in the living room was sealed with a fire screen.

Bedroom #1 is a single room and Bedroom #2 and Bedroom #3 are shared rooms. All bedrooms were furnished with a bed, a night stand, a lamp, a dresser, a chair and a built in closet in bedroom #1 and bedroom #3. Bedroom #2 has portable closet.

Bed linens were observed in the hallway and towels in the common bathroom closet.

The common bathroom is equipped with tub, a toilet, shower chair and a sink. The water temperature tested 100.1 degrees Fahrenheit. The private bathroom inside bedroom #2 is equipped with a walk in shower, a toilet and a sink and a shower chair. The water tested 101.4 degrees Fahrenheit. The back bathroom just has a walk in shower with a shower chair. All 3 bathrooms have grab baths and slip