Pre-licensing visit·February 9, 2022

Today's pre-licensing visit was conducted by Licensing Program Analyst (LPA), Sandra Urena. The LPA arrived at the facility at 9:00 a.m., and met with applicant Luiza Hekimyan. This is an application for a Change of Ownership (CHOW). The LPA, and the applicant 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. KITCHEN : Kitchen knives are stored locked and inaccessible in a kitchen drawer. A seven day supply of non- perishable foods was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. There is an adequate supply of emergency food. Kitchen, laundry, and house cleaning supplies are stored, locked, and located in the kitchen, and in the laundry room. Hot water temperature was recorded at 105 degrees Fahrenheit. BEDROOMS : There are six bedrooms for resident use, and one bedroom for staff use. Lighting in the rooms appeared adequate. All bedrooms had adequate closet and drawer space for clothing and personal belongings. BATHROOMS : The bathrooms are fully stocked with paper towels, hand soap, and hand washing signs. The showers have non-skid mats. Hot water temperature was recorded at 105 degrees Fahrenheit. Continues on LIC 809C... COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other activity supplies in the living room. Resident and staff records are stored in the staff’s room. The first aid supplies were complete, including a thermometer and a current version of a first aid manual were stored in the staff’s room. Medications are stored in a locked top cabinet in the kitchen area. The facility’s smoke/carbon monoxide alarm systems were found to be in operating condition. There are two fire extinguishers throughout the facility. One fire extinguisher was serviced on 3/2021 and one fire extinguisher, located by the kitchen area was purchased on 8/2021. The laundry area is located in an adjacent room by the kitchen area. The supply of extra bed and bath linens is adequate. There is a functioning land line telephone on the premises, one portable and one stationary. Infection control and other posters are posted throughout the facility and hallways. The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the outdoor, backyard area of the facility, and is furnished with outdoor furniture for residents’ use. The building has a central entrance for residents and visitors. Fire emergency gates are clear of obstructions. Applicant completed Component III orientation at this time. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved for Change of Ownership. Exit interview was conducted and reviewed with applicant, Luiza Hekimyan. A copy of the report was provided via email.