Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the CARE Inspection Tool and was let into the home by Ofelya Mkrtchyan, Staff. The designated Administrator Liza Gasparyan was contacted by staff and advised of today's visit. Per information provided by the designated Administrator, she is also an Administrator at another home and is working at the other facility and could not participate, in person, in today's the visit. The visit was conducted with Edgar Mkrtchyan, Licensee. The reason for today's visit was provided.

The Facility is a single storey family home consisting of a living room, dining room, kitchen, 3 bedrooms and two full bathrooms. Attached to left side of the home is an ADU with a separate address - 13937-1/2 Cantlay Street and is not part of the facility operations. Located in the back is a swimming pool enclosed with a 5 feet rod iron fence. The gate is secured with a padlocked. The facility is fire cleared for 5 non-ambulatory and 1

bedridden residents. Bedroom #3, located in the back is fire cleared for bedridden use.

On today's visit, the CARE Inspection Tool was used to conduct the visit and due to difficulty obtaining records and language barrier, the Resident Records/Incident Reports domain was the only domain that was reviewed on today's visit. Also reviewed on today's visit were 4 resident and 4 staff files. The following was observed on today's visit:

Resident #1 and Resident #3 files were missing the Centrally Stored Medication Destruction Record

Resident #2 is missing evidence of a TB test

Resident #2 and Resident do not have a completed/signed Admission Agreement and rental rates