Facility Evaluation Report

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee was let into the home by Gulshair Iusupova, Staff. Staff contacted the Administrator via telephone and she arrived at 11:16am to conduct the visit. The reason for today's visit was provided.

The facility is a single storey home consisting of a living room, dining room, kitchen, 3 bedrooms and 2 full bathrooms and a fenced in swimming pool. Located in the back of property is a separate 2 storey ADU. The facility has a fire clearance for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #1 is the approved room for bedridden use.

On today's visit, all 12 domains of the CARE Inspection Tool was reviewed. LPA Yee also reviewed 6 resident and 8 staff files and conducted a tour together with the Administrator of the entire facility, inside and outside, on today's visit.

The living room, dining room and kitchen had the appropriate furnishings and equipment for its designated use. The fireplace was covered with a fire screen and made inaccessible to the residents in care. Located inside the kitchen are the 2 fire extinguishers purchased on 3/15/26. Sharp knives are stored in a locked kitchen drawer, to the right of the stove.

Sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed in the kitchen refrigerator, kitchen cabinets and the 2 refrigerators located in the covered patio located in the back. Drinking water was stored in the shed located by the swimming pool.

The three resident bedrooms are shared rooms furnished with 2 hospital beds, 2 chairs, 2 night stands,