Facility Evaluation Report

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 09:00 A.M. LPA initially met with facility caretaker, Tilebkul Ibramov. Licensee/Administrator was contacted via telephone and arrived at 09:23 A.M. Entrance interview conducted.

Beginning at 09:46 A.M. the LPA, along with Licensee/Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Please note: the facility is a 2-story house; the upstairs area is inaccessible to residents in care and is used for staff only, therefore was not observed. The following was observed in the downstairs area:

Hardwired combination smoke and carbon monoxide detectors were tested at 10:00 A.M. and were functional at the time of the visit. Fire extinguisher was observed to be fully charged and last serviced on 11/20/2024. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit.

BEDROOMS: There are 5 (five) total bedrooms; 4 (four) are designated for private resident use and 1 (one) is a shared bedroom. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.