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 Gohar Hovhannisyan, Staff. Siranush Bagdasarian, Administrator was contacted by staff and she arrived at 10:29am to conduct the visit.

The facility is a single storey family home consisting of a living room, a dining room, a kitchen, 3 resident bedrooms, 2 common bathrooms and a attached garage. The facility is fire cleared for 5 non-ambulatory and one bedridden resident. Bedroom #3 is the room designated for the one bedridden resident. No bodies of water were observed on the property.

On today's visit all 12 domains of the CARE Inspection Tool was reviewed, 6 resident files and 5 staff files were also reviewed. A tour of the physical plant, inside and outside, was conducted.

The following was observed on today's visit:

the living room, dining room and kitchen were all appropriately furnished and equipped for it's designated use. The fire place had the required fire screen.

all three bedrooms were all equipped with 2 each of the following: hospital beds, night stands, dressers, lamps, chairs and a built in closet. All the windows had blinds for privacy.

The common bathroom by the resident rooms is equipped with a tub/shower, grab bars, shower chair, slip resistant mat, a toilet, another grab bar and a single sink vanity. Water temperature was tested and read 111.4 degrees Fahrenheit.