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 Edik Sahakyan, Staff. Sahak Sahakyan, Administrator was contacted by telephone and he arrived at 11:27am to conduct the visit. Also participating in today's visit was Liana Sahakyan and Susanna Mkrtchyan. The reason for today's visit was provided.

The facility is a single storey family home consisting of an open floor plan for a living room and dining room, a kitchen, 3 bedrooms, 2 full bathrooms. Located in the back of the property is an ADU with a swimming pool. The ADU has a separate address - 6846 Varna Avenue and is not part of the facility operations. The facility is fire cleared for 6 NON-AMBULATORY residents and is approved for 4 hospice waivers.

On today's visit the following domains of the CARE Inspection Tool were reviewed: Staffing, Food Service, Resident Records/Incident Reports, Disaster Preparedness and Residents with Special Health Needs. Also reviewed on today's visit were 2 resident files, 5 staff files and Emergency Disaster Preparedness Plan. Due to time constraints a return visit is needed to complete the inspection.

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

Exit interview was conducted, APPEALS RIGHTS were discussed and a copy was given