Facility Evaluation Report

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff,Irene Lantang and Chris Raig, and explained the reason for the visit. Staff does not have background clearance, Immediate Civil Penalty (LIC 421CG) will be issued. Approximately, around 9:55 AM new licensee, Tigran Gevorgyan, arrived and was explained for the reason of the visit. New licensee is not associated with the above facility and an application was receive from Centralized Application Bureau (CAB) for Change of Ownership (CHOW) on 8.11.2025.

At 10:00 AM, with the assistance of new licensee, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 10:58 AM smoke alarms were tested and are operational. There are carbon monoxide detectors that functions properly. The fire extinguisher is located in the kitchen with a charge date of 7.16.2025. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) residents six (6) non-ambulatory resident, of which one (1) maybe bedridden, cleared for bedroom #2; hospice waiver for five (5).

Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen.

Bedrooms: There were three (3) bedrooms designated for residents' use. Bedroom #1, bedroom #2, and bedroom #3 are shared and is used for residents only, Bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C