Facility Evaluation Report

Licensing Program Analyst( (LPA) Chrisitne Yee conducted an announced Prelicensing and Component III visit and met with Kachik Remelyan, Applicant and Designated Administrator.

The home is a single storey family home consisting of a living room, dining room, kitchen, 4 bedrooms, 3 full bathrooms and a attached garage. The facility is fire cleared for 5 non-ambulatory residents and 1 bedridden resident. Bedroom #1 is fire cleared for a bedridden resident.

The following were observed on today's visit:

The living room is furnished with a sofa, love seat, a armchair, a coffee table and a television. Located in the living room is a fire place that is sealed off with a fire screen since the fire place will not be used.

The dining room is furnished with a large table and 8 chairs. A filing cabinet to store resident and staff files were observed.

The kitchen is equipped with a stove, dishwasher and a refrigerator. Medications will be stored in a locked kitchen cabinet and sharp knives stored in a locked drawer. 8 sets of dinner plates, salad plates, bowls, glasses and 12 coffee cups were observed. Also observed were 8 of each - forks, knives, tablespoons and teaspoons. Pots, pants and cooking utensils were observed. Dish soap will be stored in a locked cabinet under the kitchen sink. No perishable foods were purchased for today's visit but will be purchased prior to accepting the first resident. Non-perishable foods for 7 days need to be supplemented to meet Title 22 requirements. Located in the kitchen is the only fire extinguisher, purchased on 9/30/23.

Bedrooms #1 and Bedroom #3 both contain I bed, 1 chair, 1 night stand, 1 lamp, a dresser and a built in closet in bedroom #1 and a portable closet in bedroom #3. The required bed linens were observed except no blankets were observed. The beds need box springs. Blinds were observed on bedroom