Facility Evaluation Report

Licensing Program Manager (LPM) Mary Flores and Licensing Program Analysts (LPA), Leslie Ngo-Castaneda conducted an unannounced required 1-year inspection at this facility at approximately. LPA were greeted by staff, Dmytro Dovgenko and Iryna Dovgenko and was explained the reason for the visit. At 2:09 PM the administrator, Karina Gevorkian, arrived and was disclosed the purpose of the visit. At 2:30 PM licensee arrived, Iryna Raskopina, arrived and was disclosed the purpose of the visit

LPA conducted a tour of the physical plant at approximately 2:10 PM to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

Common areas were observed for the ability to safely serve the needs residents. These included the kitchen, dining room area and living room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately.

LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The

kitchen food supply was observed and sufficient for the six (6) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in locked kitchen cabinet. The resident medications are locked in office cabinets by the office. The medications were observed to be inaccessible to residents. There is one (1) fire extinguishes located in the kitchen. Fire extinguishers observed to be charged at 9.23.2025.

Laundry room is beside the kitchen. The appliances observed to be functional.

Due to time constraints this required annual will be completed at a later time. Exit interview conducted/Copy of report given