Facility Evaluation Report

On 4/25/25 at approximately 9:25am, an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the Caregiver Sofia Raskopina, who granted access to the facility. LPA introduced herself by showing her department badge and explained the reason for the visit. Shortly after the Administrator, Rena Danielyan arrived and helped with documents.

During today's visit, LPA conducted a physical plant walk through, at approximately 9:50am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22.

The following was observed: The facility is a single-story home and is licensed for capacity of six (6) residents, of which six (6) may be Non-Ambulatory, Bedroom #3 is approved for Bedridden. Facility also has hospice waiver for six (6) residents. There are six (6) bedrooms, of which five (5) bedrooms are designated for residents’ use and one (1) bedroom is designated for staff use only. All bedrooms observed to be appropriately furnished and have appropriate lighting. There are four (4) bathrooms in the facility of which three (3) are designated for residents’ use and one (1) for staff use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 10:25am to be 108.7°F. Extra towels and linens were readily available in the linen closet located in the hallway. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. LPA observed facility alarms were present on all exit doors and all of the signals were functional.

SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 11:15am they were tested and observed to be operational. The facility has one (1) fire extinguisher that was last purchased on 3/5/2025.