Facility Evaluation Report
On 2/26/2025 at 9:00am Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the Caregiver/DSP Kayizzi Muhammad who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. LPA Khurshudyan reviewed the required postings on a wall next to the kitchen area. The Co-Administrator arrived at approximately 11:00am.
The inspection tool was used to complete the visit.
At 9:25am. LPA with the help of the caregiver began a physical plant tour of the facility and the following was observed: This is a single-story building with four (04) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for four (4) clients. Facility is operating level 3 clients.
Kitchen: LPA observed a seven-day supply of non-perishable food and a two-day supply of perishable foods properly stored and labeled. Facility stores knives, sharps, first aid kit, emergency supply of food / water and clients’ medications inside separate kitchen cabinets which are always locked and under supervision. Facility records are kept inside locked commercial cabinets next to the office area. LPA observed fully charged one (1) fire extinguisher located in the kitchen by the pantry door. Fire extinguisher service date is 09/20/2024. A weekly menu was also available.
Common Areas: These include living and dining areas . LPA observed dining, living areas clean and clear of clutter. Furniture is generally new and in a good repair Dining and living room furniture sits the capacity of the facility. Walls, floors, windows, screens, and blinds were clean and in good repair. At 11:00am. LPA measured the room temperature to be 69 degrees Fahrenheit. There is a linen closet in the hallway with an adequate supply of fresh linens ready to use. No obstructions and or tripping hazards throughout the facility. Facility has landline, LPA checked it was operational. Continue on LIC809-C
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction