Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection and was let into the home by Seda Hovhannisyan, Staff. Mary Petikyan, Administrator was contacted by staff and she arrived at 11:16 a.m. to conduct the visit. The reason for today's visit was explained.

The facility is a single storey family home consisting of a living room, office, kitchen, dining room, family room, 5 bedrooms of which one is used as a staff room, 2 common bathrooms, 1 private bathroom and a detached garage located in the back of the property. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #4 is approved for bedridden use.

All 12 domains of the Inspection Care Tool were reviewed, 5 residents and 8 staff files were reviewed on today's visit and the following were observed:

The living room was furnish with the appropriate seating and coffee table. The fire place was observed with a secured with fire screen. Located in the living room is a fire extinguisher purchased on 3/25/25. The second fire extinguisher is located in the family room and was also purchased on 3/25/25.

The office was observed with a table, 4 chairs, a bench, a printer and a file cabinet used to store the residents' medications.

The kitchen is equipped with a stove, refrigerator, microwave and a center island with bar stools. Perishable foods for a minimum of two days and non-perishable foods for a minimum of 7 days were observed. Adjacent to the kitchen is the breakfast nook furnished with a table and four chairs.

Located by the kitchen is the staff bedroom furnished with a bed and has a refrigerator with additional