Facility Evaluation Report

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit and met with the applicant Narek Nersisyan. This is a new facility application for a Residential Facility for the Elderly (RCFE) for six (6) non-ambulatory residents; one (1) of which may be a bedridden resident(s). Waiver was granted for hospice care for six (6) residents. Fire Clearance was approved on 10/28/2024. Bedridden approved in bedroom #2. ADU unit NOT INCLUDED in fire clearance.

At 10:05 a.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility will be following Title 22 Regulations.

COMMON AREAS: The living room area is equipped with a television, and table games. There is a dedicated area for the posting of required documents at the entrance of the facility. Smoke alarm were tested and functional at the time of the visit. The residents’ and staff files will be stored and locked in a file cabinet located in the corner of the common area.

KITCHEN: Kitchen knives are stored locked and inaccessible in a locked kitchen drawer. A seven-day supply of non-perishable food was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 113.5 degrees Fahrenheit. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. Medications will be stored in a top locked cabinet in the kitchen area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. A fire extinguisher is located near the backdoor exit, which was purchased on 08/14/2024. LAUNDRY: The washer and dryer are located outside in the backyard area. Detergents and cleaning supplies will be stored in a locked cabinet under the kitchen sink.

BEDROOMS: There are four (4) bedrooms for residents in care. Rooms # 1 and 2 will be used as private rooms. Room #2 is approved for one (1) bedridden resident. Rooms # 3 and 4 will be shared rooms; all bedrooms are cleared for non-ambulatory. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available. Linen closet is located outside bedroom #4, and has a sufficient supply of linens. Continues on LIC 809C...