Facility Evaluation Report

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Caregiver Elma Parohinog. Administrator (AD) Ashkan Bastani was notified via telephone by staff.

For today’s visit, LPA observed a total of six residents in care and two staff members on duty.

LPA observed the Administrator's Certificate for facility AD Ashkan Bastani which expires on October 22, 2027.

LPA Ramirez toured the interior and exterior portions of the facility with Caregiver Parohinog. The facility is a one-story home and is licensed for five non-ambulatory clients and one bedridden. The facility has a Hospice waiver for four. There are a total of five bedrooms of which four are for residents and one for staff. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. LPA observed all windows were screened. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of two restrooms. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 107.8-109.9 degrees Fahrenheit.

Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Fire extinguisher was observed to be fully charged and mounted by the kitchen. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable.