Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and met with Zhanna Davtian, Administrator. The reason for today's visit was explained.

The facility is a single storey family home consisting of a living room, a dining room, a kitchen, 4 resident bedrooms, 3 full bathrooms and a attached garage. The bathroom located by the kitchen is designated for staff us. Previously located along the left side of the home and directly behind the garage was a fenced in swimming pool that has since been fenced off as part of the property for the ADU. The ADU has a separate address of 14648 Runnymede Street and is not part of the facility operations. The home is fire cleared for 5 NON-AMBULATORY and 1 bedridden resident. Bedroom #3 is designated for bedridden use.

On today's visit, all 12 domains of the CARE Inspection tool was reviewed. Also reviewed were 6 resident and 7 staff files. A tour of the physical plant, inside and outside, was conducted and the following were observed:

the living room and dining room were furnished with the appropriate furniture for 6 residents. The fireplace in the living room was covered with a fire screen.

Bedroom #1 and Bedroom #3 were observed with 2 each of the following - hospital beds, chairs, night stands, lamps and a shared dresser and closet.