Facility Evaluation Report

License Program Analysts (LPA) Luis De Leon conducted an unannounced annual required visit. LPA met with Caregiver Karine Chilingaryan who informed Administrator of today’s visit. Administrator Armen Markosian joined the visit a few minutes later . The purpose of today’s visit was explained. The facility is licensed to serve six (6) non-ambulatory residents, age 60 and over. The facility is approved for one (1) bedridden resident and six (5) hospice waiver.

The LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows:

The facility is in a residential area and is made up of four (4) Resident bedrooms, two (2) full bathroom including a private bathroom, living room, Dining room, laundry room in the garage, front and backyard, and a detached car garage. There were no body of water ob served in the property.

Resident record review consisted of Admission Agreements, Identification and Emergency Info, Physicians Report, Consent Report, Individual Program Plan, Hospice plan for 2 residents, Personal Rights, and Centrally Store Medication. Staff record review consisted of Personnel Report, Health Screening, Criminal Record Statements, Fingerprint Clearance, and Training. LPA observed that S1-S4 were missing First Aid Certificate in file. In addition, S1 and S3 were missing Health Screening records. Deficiencies were noted and record in LIC-809D.