Routine inspection·September 15, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 11:28 AM. LPA contacted the facility Administrator Knarik Davtyan. The Administrator stated that they were unable to come to the facility at the time of the visit but stated that Staff #1 (S1) could conduct the annual visit with LPA. The Administrator advised LPA that the facility does not currently have residents. Beginning at 12:02 PM, the LPA along with S1 toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN : The kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured cabinet to contain knives and other sharp objects. LPA observed an additional secured cabinet designated to store resident medications. COMMON AREAS : This includes the living room and entry area. LPA observed the living room to be clean and properly furnished. Auditory alarms on the exit door to the backyard were disabled at the time of the visit. The living room was observed to contain activities for resident use. The entryway was observed to be clean and contained all requires postings. The entryway contains an appropriately screened fireplace and adequate seating. LPA observed the facility hallway to contain a pantry that contained adequate emergency food supplies. The LPA observed two hallway closets to contain extra linens and space for resident storage. LPA observed the fire extinguisher to be fully charged and was serviced on 10/01/2024. Combination smoke and carbon monoxide detectors were tested at 12:22 PM and all were functional at the time of the visit. No fire clearance concerns were observed. Continued on LIC 809C. BATHROOMS : There are two (2) bathrooms for resident use. One (1) is a shared resident bathroom and one (1) is a private resident bathroom. Bathrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the resident bathrooms and all were secured at the time of the visit. The water temperature was measured in both restrooms at 108.5 degrees Fahrenheit which is in compliance with regulation. BEDROOMS : There are four (4) total bedrooms in the facility. Two (2) rooms are designated as dual occupancy rooms and two (2) are single occupancy rooms. Bedroom #1 is designated as the bedridden approved room. Resident rooms were observed to be missing resident beds. Resident bedrooms contained all other required furnishings and sufficient lighting. All resident bedrooms were equipped with emergency flashlights. GARAGE: The garage was observed to be appropriately secured. The garage contains adequate emergency water, a washer and dryer, extra care supplies, and appropriately stored cleaning supplies. OUTDOOR SPACE: The backyard has patio furniture including shaded tables and chairs for resident use. The facility has clear passageways for emergency exit use. All ramps observed were secured properly and were in good repair. EMERGENCY DISASTER PLAN: During today's visit LPA reviewed the facility's emergency disaster plan. The facility's policies and procedures are adequate. LPA did not observe when the plan was last reviewed/updated by the facility's Administrator. Due to the facility having no residents in care no interviews were conducted and no citations were issued. LPA reminded the facility Administrator to notify Community Care Licensing Division (CCLD) upon the acceptance of their first resident. This report was read to the Administrator via telephone call. The Administrator has designated S1 to sign this report on their behalf. Exit interview conducted and report was issued.