Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Tan conducted an Annual Required visit and inspection of this facility. LPA met the House Manager Narine Bogosyan and explained the reason for the visit. The facility is fire cleared for six (6) non-ambulatory residents, one (1) of which may be bedridden on Room #2, hospice waiver for six (6) residents.

LPA conducted a physical plant tour at 9:15 AM., and observed the following:

Kitchen: LPA observed the kitchen to be clean and clear of clutter. Appliances and fixtures were functional. LPA also observed a 7 day supply of non-perishable amount of food and a 2 days supply amount of perishable food in the facility. Cleaning products were observed to be locked in a the laundry room.

Bedrooms: LPA observed a total of four (4) bedrooms designated for residents' use on two (2) private and two (2) shared bedrooms. Residents' bedrooms were observed clean and free of clutter, properly furnished with appropriate beds, night stands and chairs. Doors in bedrooms leading to the outside had auditory alarms that were observed functional. LPA observed night-lights through out the facility.

Bathrooms: There are two (2) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 115.0°F. and 115.9°F.