Facility Evaluation Report

The pre-licensing visit was conducted by Licensing Program Analyst (LPA), Sandra Urena. The LPA arrived

at the facility at 09:40 a.m., and met with applicant Nelli Tadevosyan. This is a new facility application for a total of six residents, five (5) non-ambulatory, and one bedridden. Fire Clearance was approved on 11/18/2022 for one bedridden resident, and resident is allowed to reside in bedroom #3.

At 09:45 a.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there

are no health and safety hazards, and facility is in compliance with Title 22 Regulations.

KITCHEN: A seven day supply of non-perishable food was available. The supply of dishes is adequate.

Appliances in the kitchen were clean and all appeared functional. House cleaning supplies will be stored in locked cabinet under the sink. Hot water temperature was recorded at 118.2 Fahrenheit degrees.

There were no pesticides or toxins stored near food, or preparation area. Trash cans did not have a tight-fitting lid.

BEDROOMS: Facility has three (3) bedrooms for resident use. There is no bedroom available for staff use. Bedrooms are for double occupancy. Bedroom #3 is approved for one (1) bedridden resident. Lighting in the rooms appeared adequate. All bedrooms had adequate closet and drawer space for clothing and personal belongings.

BATHROOMS: The facility has two bathrooms. Bathrooms are fully stocked with paper towels, and liquid hand soap. The showers have non-skid surface mats. Hot water temperatures were recorded in Fahrenheit degrees as follows:117.6 degrees for bathroom #1, and 118.2 degrees for bathroom in bedroom #3. Hand washing signs were visible and posted. Toilets will be equipped with adjustable handlebars/Safety toilet rails.