Facility Evaluation Report

Licensing Program Analyst (LPA) Zabel Chochian arrived to this facility today to conduct a Required Annual inspection. LPA met with staff and Administrator Anait Domio. Reason for the visit was explained. The facility serves level 3 clients from North Los Angeles County Regional Center. There is sufficient staffing to meet the needs of clients in care. LPA observed four (4) clients in the home resting in their rooms.

At approximately 4:30pm-5pm, LPA toured the facility with Administrator and staff. The kitchen appeared to be clean and the appliances and fixtures functional. LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects were observed stored in the locked drawer in the kitchen. Medications were observed stored in a locked cabinet also in the kitchen. The home consists of a master bedroom with bathroom which is occupied by two (2) clients and two private rooms occupied by clients. The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each client. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a sufficient supply of personal hygiene for client use. LPA observed two bathrooms to be clean and had functional fixtures. Bathrooms observed stocked with necessary hygiene products (soap, paper towels, toilet paper etc). Laundry area observed in the kitchen. All detergents were observed locked in cabinet. Garage entrance is from the outside. LPA toured the garage and observed sufficient PPE supplies, extra paper towels, toilet paper, supply of water and an extra refrigerator stocked with additional food supply.

At approx 5:30pm the facility smoke detectors and carbon monoxide were tested and functioned properly.

There is no staff room therefore facility provides 24 hour care. Administrator will check with local fire department to see if the facility office space may be used as staff room. If so Administrator will inform Licensing and submit required LIC200 and facility sketch to obtain clearance for a staff room.

Front/backyard - Observed clean and free from any hazards during todays visit.

Due to time constraints, annual visit will continue at a later date. Exit interview held. Copy of report issued.