Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the CARE Inspection Tool and was let into the home by Margarit Babayan, Staff. Sargis Ayvazyan, Administrator was contacted by phone and he arrived at 11:26am 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, dining room, kitchen, 4 bedrooms of which one is used for live-in staff, an 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 domains were reviewed on today's visit: Operational Requirements, Personnel Requirements/Staff training, Planned Activities, Incidental and Medical, Resident Records/Incident Report and Residents with Special Health Needs. Also reviewed on today's visit were 4 staff files and 6 resident files. A return visit will have to be conducted to complete the annual inspection.

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Any citations not addressed on today's visit will be addressed on a return visit.

Exit interview was conducted, Appeals Rights were discussed and a copy was provided.