Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was let into the home by Eva Martirosian, Staff. Staff contacted Siranush Bagdasarian, Administrator via telephone and she arrived at 11:18am to conduct the visit. The reason for today's visit was provided.

The home is a single storey family home consisting of a living room, dining room, kitchen, four resident bedrooms, 2 full bathrooms, a staff lounge and a attached garage. The facility is fire cleared for 5 non-ambulatory residents and 1 bedridden resident. Bedroom #3 is approved for bedridden use.

On today's visit, all 12 domains of the CARE Inspection Tool was reviewed. Also reviewed on today's visit were 5 resident files and 5 staff files.

The following were observed on today's visit:

the living room, dining room and kitchen were equipped and furnished with the appropriate furnishings and equipment for its designated use. The fire place in the living room was covered with a fire screen.

Bedrooms #1 and Bedroom #3 are double occupancy rooms with 2 hospital bed, 2 night stand, 2 lamp, a built in dresser in Bedroom #1, a single dresser in bedroom #3, 2 chair and a closet.

Bedroom #2 and Bedroom #4 are single occupancy rooms with a hospital bed, a night stand, a chair, a lamp, a dresser and a built in closet in bedroom #2 and a portable closet in bedroom #4.

the common bathroom located by the front door has a toilet, 1 sink vanity, a shower stall equipped with grab bars and a non-skid mat. Water temperature was tested at 4:13pm tested and it read 116.8 degrees Fahrenheit

the common bathroom located by the resident bedrooms has a walk in shower, a single sink vanity, a