Pre-licensing visit·October 30, 2025

Licensing Program Analyst(LPA) Christine Yee conducted an announced Prelicensing and Component III visit to ensure that the home meets Title 22 requirements. The CARE Inspection Tool was used to conduct the visit. LPA Yee met with Junaida Shakhvaladyan, Applicant. The home is a single storey family home consisting of a living room, dining room, kitchen, 4 bedrooms of which one is designated for live-in staff, 3 full bathrooms and a attached garage. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. On today's visit, LPA Yee reviewed all 12 domains of the CARE Inspection Tool, reviewed the Emergency and Disaster Plan, Residential Infection Control Plan and toured the entire physical plant, inside and outside. The following were observed: The living room is furnished with a sofa, 2 armchairs, 2 coffee tables, a wall mounted television and a television stand. Additional seating is needed. The fire place is made inaccessible by a fire screen. The dining room is furnished with a long table and six chairs, a buffet table, 2 plant stands with potted plants and the centrally stored medication cart. The kitchen is equipped with a stove, dishwasher, refrigerator, microwave, air fryer and a toaster oven. There are sufficient dinner plates, salad bowls, glasses, cups, soup bowls, knives, forks and spoons. Pots and fry pans were observed. There were no perishable foods purchased. Non-perishable foods were observed in the attached garage but were not in quantities to last for 7 days. Knives are stored in a continued on LIC809-C Page 2. locked cabinet and dish soap and cleaning supplies are stored in a locked cabinet under the kitchensink. Laundry detergent and additional cleaning solutions are stored in a locked cabinet in the garage. Also located in the kitchen is a round table with 4 dining chairs and a fire extinguisher purchased on 6/25/25. The facility has a second fire extinguisher that is not currently mounted. Bedroom #1, located by the front door is designated for staff use. It is furnished with a full size bed, a night stand a lamp, a built in closet, a desk and a coffee table. Bedroom #2 is furnished with a full size bed, a night stand, a chair, 1 night stand, a lamp, a built in closet and a mounted television. The required linens were observed except for a blanket. Located inside the bedroom is a bathroom equipped with a walk-in shower, a toilet and a single sink vanity. Grab bars were observed in the shower and on the wall directly by the shower. A grab bar is needed by the toilet. A slip resistant mat was observed The water temperature was taken and it read 114.2 degrees Fahrenheit. Blinds were observed on the 2 windows. Bedroom #3 is furnished with 2 hospital beds with half bed rails, 1 chair, 2 lamps, a built in closet and a sliding glass door. Located outside is a ramp. A auditory device was mounted on the door. Bed linens were observed but there was no blanket. The common bathroom is equipped with a bath tub/shower, a toilet, single sink vanity and storage cabinets. Grab bars and a slip resistant mat were observed. Water temperature was tested and read 112.6 degrees Fahrenheit. Bedroom #4 is furnished with a queen sized bed, 2 night stands, 2 lamps, connected armchairs, a walk in closet and a wall heater. Located inside is a bathroom equipped with a shower stall, a toilet, a single sink vanity and a large jacuzzi tub.. Grab bars and a slip resistant mat were observed in the shower and by the toilet. The water temperature was tested and read 106.5 degrees Fahrenheit. The linen closet was observed with 7 sets of towels, 6 sets of twin sheets. The first aid kit was observed with the appropriate gauze, salves, bandages, tweezers, scissors and thermometer. No first aid manual was observed. All the windows had blinds for privacy and the screens were observed to be in good condition. continued on LIC809-C Page 3 The smoke detectors were tested individually and were operational except for the smoke detector located by the front door. The smoke detector was missing. The attached garage houses the washer and dryer and is primarily used for storage. The 2 non-operational refrigerators need to be discarded. The backyard has a covered patio furnished with plenty of chairs and a table. Also located in the back is a free standing gazebo equipped with benches and barbecue grills and directly adjacent to the gazebo are additional chairs. 2 storage sheds were observed. Ladders, hoyer lift, swing set, wood, cleaning buckets, mops were stored in the back and along the side of the home. Otherwise the back yard was observed to be clean The front yard was also observed to be clean but the water hose needs to be rolled up. The following corrections need to be addressed prior to licensure: the queen size bed in bedroom #4 and full size bed in bedroom #2 needs to be replaced with 4 individual beds. A chairs needs to be placed in bedroom #2, #3 and 2 chairs in bedroom #4 a dresser is needed in bedroom #2, #3 and #4 a night stand in bedroom #2 remove bed rails from the 2 hospital beds in bedroom #3 purchase blankets and sets of towels in quantities to allow for changing weekly or as needed. purchase a carbon monoxide detector, if smoke detectors are not combination carbon/smoke detectors. replace the smoke detector by the front door. purchase additional non-perishable foods for a minimum of 7 days purchase hygiene products. remove the shoe rack located by the front door. complete a fire safety plan review and revise the Emergency Disaster Preparedness Plan continued on LIC809-C Page 4. add additional seating in the living room for 6 residents secure and make the wall heater inaccessible to the residents purchase a telephone for the facility and ensure the telephone is operational purchase a first aid manual that is approved by the American Red Cross discard or store the ladders, buckets, mops, exercise equipment stored out in the back and along the side of the home and roll up the garden hose in the front Applicant to notify LPA Yee once the corrections have been completed, but longer than 11/6/25 to schedule a second visit to clear the home. COMPONENT III was not conducted on today's and will be scheduled on the return visit. Exit interview was conducted.