Facility Evaluation Report

At 9:30am Licensing Program Analysts (LPA) Leizl de la Cerra conducted an announced Pre-Licensing Inspection to the above facility and met with Licensee Kathrine Nagapetyan. The LPA will inspect the facility to ensure that the facility is in compliance with the rules and regulations under California Code of Regulations, Title 22, Division 6.

Fire Clearance was approved on 02/29/2024 for a maximum capacity of six (6) residents, of which five (5) are for non-ambulatory and one (1) for a bedridden resident in room #1. Facility was also approved for a Hospice waiver for six (6) residents on February 01, 2024. The facility is a single-story building. At 9:45am, with the assistance of the Licensee, LPA conducted a facility tour of both the inside and outside premises and observed the following:

KITCHEN: The kitchen is equipped with a refrigerator, microwave oven and sink. At 9:50am, the team observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The medications will be kept in the kitchen cabinet and LPA observed the cabinet is locked and inaccessible to residents in care. The first-aid kit is complete. There is a three drawer locked cabinet and will contain resident and staff records.

The facility smoke alarm system is hard wired and interconnected. The fire extinguisher is located near the dining area and was observed to be fully charged and was last purchased on 02/27/24. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Alarms were tested and observed to be operationa l.