Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced visit and was greeted by the staff Samantha Baltazar who called the Administrator. Administrator Sona Galstyan arrived about an hour later. LPA explained the reason for the visit. The facility is fire cleared for six (6) non-ambulatory residents, five (5) of which may be bedridden in Rooms 2 to 4. Hospice waiver for six (6) residents.

At 9:21 AM, LPA conducted the physical plant tour with the staff and observed the following:

The facility is a single storey with six ()6 bedrooms and four (4) bathrooms. Two (2) bedrooms and one (1) bathroom is designated for staff use. Dual smoke and carbon monoxide alarms were tested and observed to be operable. The facility is equipped with sprinkler system.

Common Areas – The family room, dining room, and kitchen are combined. The family room was furnished with comfortable seating and a television. The dining room contained a dining room table and chairs. Fire extinguishers were located near the kitchen and the main door upon entry and last inspected on 11/14/25.

Medications: LPA observed the resident medications and first aid kit were safely locked in a kitchen cabinet.

Kitchen: LPA observed a two day supply of perishable food and a seven day supply of non-perishable food items. Dishwashing liquid and other cleaning agents were observed locked underneath the kitchen sink.

Laundry Room is located adjacent to the kitchen and was observed to be locked during visit. Laundry detergent and other toxins were locked in the garage. (continued on LIC 809-C)