Facility Evaluation Report

Licensing Program Analyst (LPA) LaQueena Lacy arrived at the facility on 06/01/2023 at 10:47AM to conduct an announced Pre-Licensing visit and met with Administrator Ani Ghazaryan. Entrance Interview conducted with the administrator and explained the purpose of today’s visit, is to inspect the facility and ensure compliance with rules and regulations California Code of Regulations, Title 22, Division 6.

Today's site visit consisted of the LPA and administrator touring the physical plant at 11:02AM inside and outside the following was observed: The facility has one main entrance being used, there are required signage (Facility Exit Plan, Emergency/Disaster Contact information etc.) posted. The facility is a single-story building with five (05) bedroom and two (02) bathrooms. The facility fire clearance is granted for (05) non-ambulatory and one (01) bedridden resident. The facility temperature observed to be in range of 73 degrees Fahrenheit (F).

Kitchen: At 11:03AM LPA observed the kitchen to be clean and free from obstruction. Appliances observed

to be in good repair and functional. LPA observed sharps at 11:08AM to be stored and locked in a top drawer to the right of the stove inaccessible to resident by a magnetic lock. At 11:13AM LPA observed a bathroom and a storage room adjacent to the kitchen labeled employees only locked and inaccessible to resident to be the laundry area and storing toxins, and cleaning supplies clean and clear from debris or obstruction. LPA observed a closet near the kitchen to be storing the emergency food, dry food, canned goods, fruits, and vegetable. A fire extinguisher located on the wall in the kitchen to the left of the sink to have a purchase receipt from Home Depot dated 10/08/2022.

Bedrooms: At 11:23AM LPA inspected (05) bedrooms, bedroom number (02) is designated for the live in staff and storing extra linen and comforters. All bedrooms observed to be clean and appropriately furnished and equipped with adequate lighting and bedroom furniture.