Pre-licensing visit·January 15, 2026

Licensing Program Analyst(LPA) Christine Yee conducted a subsequent announced Prelicensing and Component III visit to ensure that the deficiencies observed on the initial Prelicensing visit conducted on 10/30/2025 were corrected and to complete Component III. LPA Yee met with Junaida Shakhvaladyan, Applicant. Per tour of the home on today's visit, the following corrections were made: the queen size bed in bedroom #4 and full size bed in bedroom #2 were replaced with 2 beds in each room. another chair was placed in bedroom #2, #3 and 2 chairs were place in bedroom #4 a shared dresser was placed in bedroom #2, #3 and #4 another night stand and lamp was placed in bedroom #2 bed rails were removed from the hospital beds in bedroom #3 sufficient blankets and sets of towels were purchased in quantities to allow for changing the hardwired combination smoke/carbon monoxide detectors were placed in all the resident rooms, staff rooms, hallways, living room and dining room. All were tested individually and were operational. plenty of non-perishable foods for a minimum of 7 days were observed 13 five gallon bottles of water were observed hygiene products were observed in a locked cabinet located inside the only common bathroom. the shoe rack by the front door was relocated The fire safety plan was reviewed. continued on LIC809-C Page 2. The Applicant provided a copy of the Emergency Disaster Preparedness Plan for review. A copy was also emailed to LPA. Chairs were added in the living room to allow seating for 6 residents the heater wires for the wall heater mounted in bedroom #4 were removed and does not generate heat and is used decoratively. The facility telephone - (747) 264-0754 was tested and was operational a first aid manual was observed the backyard was cleaned and all stored items noted on the initial report had been removed. COMPONENT III was conducted with the Applicant on today's visit. The Applicant was reminded to do the following once the licensing process has been completed: purchase general liability insurance with limits of $1 million per occurrence and $3 million total annual aggregate create files for all staff, all residents and volunteers if applicable ensure that all staff and any persons who are required to have a criminal record clearance have obtained the clearance and have requested a criminal record transfer prior to their initial presence at the facility notify the Department of the acceptance of the first resident within 5 days of acceptance. purchase perishable foods for a minimum of 2 days prior to the acceptance of the first resident As of this visit, there is no obvious corrections identified to hold up the clearance of the home. Exit interview was conducted and a copy of the report was provided.