Facility Evaluation Report

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee was let into the home by Marina Martirosian, Staff. Staff contacted the Administrator/Licensee, Alexander Otiashvili via telephone and he arrived at 10:44am to conduct the visit.

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 an approved hospice waiver for 6 residents.

The following was observed on today's visit:

Staff and resident files were incomplete and were missing majority of the required documents and did not meet Title 22 requirements

Staff have current first aid training. Evidence of first aid/CPR training expires on 6/17/1925

Staff #1 does not have a criminal record clearance

The facility has liability insurance that meets Title 22 requirements of $1 million per incident and $3 million total annual aggregate.

The facility does not have training logs/evidence of in-service training conducted.

There are no completed Admissions Agreements.

Physician's Reports available are not signed and indicate that 2 residents' are considered bedridden. The Administrator will obtain clarification and provide a copy of the updated Physician's Reports to the Department. Citations and Civil penalties will be issued if needed once clarification is obtained.

All four residents are on hospice and there are not care plans, services being provided and evidence of staff training.

Administrator Certificate for Alexander Otiashevili expires on 5/8/26.