Facility Evaluation Report

On 4/28/2025 @ 10:30am, Licensing Program Analyst (LPA) Leizl de la Cerra conducted the required 1 year annual inspection with staff/caregiver, Siranush Mkhitaryan. Administrator, G ayane Agazaryan was contacted but was unavailable. LPA was informed by the administrator that Siranush Mkhitaryan was given consent to sign the report.

This is a single story residence consists of four (4) bedrooms and two (2) bathrooms. Fire Clearance was approved on 01/17/2019 for five (5) non-ambulatory residents and one (1) bedridden in bedroom #2. All four (4) bedrooms are designated for resident use

A tour of the physical plant was initiated at approximately 11:55pm and the following was observed:

The smoke alarms and carbon monoxide detector are hard wired and inter-connected. Staff tested the dual smoke/carbon monoxide detector @12:30pm and was observed to be operational. The facility has two fully charged fire extinguishers inspected on 4/18/2025. One fire extinguisher is located in common room area, and the other in the kitchen.

KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives are kept in a locked box. There is a staff workstation located at the corner of the kitchen.

BEDROOMS: There are four (4) bedrooms designated for resident use. Bedroom #1 and #2 are private rooms, with bedroom #2 having a bedridden fire clearance (per STD 850). Bedrooms #3 and #4 are shared rooms. The resident's bedrooms are furnished with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space.

BATHROOMS: The facility has two (2) bathrooms for the resident's use. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature measured between 106°- 110°F.