Inspector’s narrative
What the inspector wrote
Licensing Program Analyst(LPA) Christine Yee conducted a subsequent announced Prelicensing and Component III visit to complete the inspection of the home to ensure that the home meets Title 22 requirements. LPA Yee met with Kristine Abasyan, Applicant and Ripa Tavitian, Consultant.
On today's visit, the last domain of the CARE Inspection Tool - Physical Plant and Environmental Safety, was reviewed, all 4 Bedrooms, Kitchen, Garage and outside areas were toured and the following were observed:
Bedroom #1 was re-organized and contains 2 beds, 2 night stands, 2 lamps, 2 dressers, 2 folding chairs and a built in closet. The window blinds were observed to be new. The private bathroom is equipped as previously noted. The water temperature in the private bathroom located inside the room was initially tested and read 131 degrees Fahrenheit and was later re-tested and read 104.4 degrees Fahrenheit when the thermostat was adjusted.
Bedroom #2 is rented as a private room and contained a hospital bed, a night stand, a folding chair, a lamp, a dresser, a built in closet, a covered trash can and a flash light. Window blinds were replaced.
Bedroom #3 is a shared room and contains 2 of each: beds, night stand, lamps, folding chairs, dressers and built in closet. New blinds were observed.
Bedroom #4 is rented as a single room with one each of: a full sized bed, a night stand, a lamp, a folding chair and a built in closet. Located inside the room is a private bathroom with a shower stall with a shower chair, grab bars, a slip resistant mat, a toilet and a single sink vanity. The water temperature was initially tested and read 124.4 degrees and was later retested after adjusting the thermostat and read 109.6 degrees Fahrenheit.
continued on LIC809-C
the common bathroom consists of a walk in shower, a toilet and a single sink vanity. Grab bars, shower chair and a slip resistant mat were observed. The water temperature when tested read 109.6 degrees Fahrenheit.
The kitchen was toured and is equipped with a stove, a microwave, refrigerator and toaster.
Per review of the food supply, perishable foods for a minimum of 2 days were observed in the refrigerator. Initially, insufficient non-perishable foods for a minimum of 7 days were observed in the garage and it was replenished during the visit. Sufficient water was also observed after additional water was purchased.
Disinfectant, cleaning solutions, hygiene products and laundry detergent is stored in a locked cabinet in the garage. Extra bedding, bath towels, face towels, hand towels, blankets, comforters are stored in a cabinet in another cabinet.
Centrally stored medications are kept in a locked cabinet located in the living room.
General Liability insurance was observed. The facility has insurance for $2 million per occurrence and a total annual aggregate for $4 million dollars from 9/24/24-9/24/25.
The required postings were shown to LPA and will be posted once license is issued. Current labor poster, Long Term Care Ombudsman Poster and Complaint were observed.
The facility visiting hours were posted on the front door.
The facility will retain the telephone # currently in place from the former owner.
The facility has an IPad dedicated for facility use and a written internet usage policy
Per tour of the backyard, a covered gazebo was observed furnished with a wicker sofa and 5 wicker arm chairs and 2 coffee tables.
The following corrections were addressed during this visit: the facility sketch has been updated to indicate assembly point, the rails in bedroom #2 were removed, the Emergency Disaster Plan was updated, fire arms policy was updated on the Admission Agreement to indicate that all firearms on the premises are prohibited, Rights of Family council, current labor poster and visiting hours were observed. The appropriate number of beds for the approved capacity was observed.
The following correction needs to be made prior to licensure:
the water temperature in the private bathroom located in bedroom #1 read 104.4 degrees Fahrenheit and needs to be within the range of 105 - 120 degrees Fahrenheit.
the hose in the backyard and front yard needs to rolled up.
Applicant will notify LPA Yee once the corrections have been completed.
The Applicant will ensure that files are created for all residents, volunteers and staff once they are licensed.
Component III was conducted with Kristine Abasyan, Applicant and Ripa Tavitian, Consultant.
Exit interview was conducted.