Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with caregiver, Ruzanna Sargsyan, to conduct a case management health and safety check. LPA spoke with Administrator, China Washington, via telephone call, who gave permission to have caregiver sign report.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and five (5) bathrooms for resident use, along with one (1) bedroom and one (1) bathroom for staff. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. Hot water temperature was observed to be 115 degrees F.

LPA reviewed five (5) resident records and two (2) staff records. LPA observed staff on the premises to have a criminal background clearance on file.

As a result of today's inspection, no deficiencies are being cited. Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these documents.