Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an announced Pre-licensing and Component III visit and met with Sargis Ayvazyan, Applicant and Marine Danielyan, Spouse/Staff.

The facility is a single storey family home consisting of a living room, dining room, kitchen, 4 bedrooms of which one is used for live-in staff, a office, a laundry room, 2 full bathrooms and a attached garage. The facility is fire cleared for 3 NON-AMBULATORY and 3 BEDRIDDEN residents. Bedrooms #1, #2 and #4 are designated for bedridden residents. The home is also equipped with a sprinkler system.

The following was observed on today's visit:

the living room is furnished with a sofa and 2 armchairs. Located in the living room is a fire place. A fire screen was not observed.

the dining room has a glass table with 6 chairs

the kitchen is equipped with a stove, microwave and 3 refrigerator. Cleaning supplies are stored in a locked cabinet under the kitchen sink. Knives are stored in a locked kitchen drawer. 13 dinner plates, 3 salad plates, 9 bowls, 4 cups, 3 plastic glasses, pots, pans, 6 dinner forks, 6 desert forks, 6 dinner knives, 6 tablespoons and 6 teaspoons were observed. No perishable foods were purchased and additional non-perishable foods for 7days were purchase during the visit. The only fire extinguisher, purchased on 7/17/23 and the carbon monoxide detector are located in the kitchen.

2 first aid kits and a first aid manual were observed in the kitchen. Tweezers, scissors were observed but no thermometer

adjacent to the kitchen is the laundry room with a washer and dryer. A linen closet with 18 bath towels, 18 hand towels and 18 face towel and extra fitted sheets were observed.

the attached garage can be accessed through the laundry room. The garage needs to be cleaned out due to excessive items stored in the garage