Facility Evaluation Report

Licensing Program Analyst(LPA) Christine Yee conducted a announced Prelicensing and Component III visit and used the CARE Inspection Tool. LPA Yee met with Alexander Otiashvili, Applicant and Maya Sargsyan, Designated Administrator.

The home is a single storey family home consisting of a living room, dining room, kitchen, 3 bedrooms, a private and a common bathroom. The home is fire cleared for 6 non-ambulatory residents. The facility has a waiver for 6 residents.

The following were observed on today's visit:

the living room is furnished with the appropriate seating, coffee table and a portable electric fire cabinet.

the dining room has a table with 6 chairs. Located in the dining room is a locked storage cabinet to be used to store the centrally stored medications and a little cabinet for resident and staff files.

the kitchen is equipped with a dishwasher, stove and a microwave. Sufficient perishable and non-perishable foods were observed. Knives are locked in a locked kitchen drawer. Sufficient, utensils, dinner plates, salad plates, bowls, cups, pots and pans were observed. The only fire extinguisher, purchased on 11/12/23 is located between the kitchen and dining room.

Bedroom #1 is furnished with 2 twin beds, 2 night stands, 2 lamps, 2 padded seats, 2 dressers and a shared closet. Required linens were observed and extra linens and towels are stored in the residents' closet.

Bedroom #2 is furnished with 2 hospital beds, 3 night stands, 2 lamps, 2 chairs, 2 dressers and a large walk in closet. Required linens were observed on the bed and extra linens, blankets and towels were observed in the residents' closet. The slate of the window blinds are warped. Located inside bedroom #2 is a private bathroom equipped with a shower stall, a toilet and a sink. Grab bars and a non-skid mat were observed. Water temperature was tested and read 117.6 degrees Fahrenheit.