Pre-licensing visit·March 25, 2026

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Hasmik Elizharyan. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been requested. The facility is a one story home. At 09:50 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory residents and, one (1) bedridden resident. The facility has two (2) private bedrooms, Rooms #4 and 5, and three (3) shared rooms, Room # 1, 2, and 3. All resident rooms have direct exits to the outside. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. Rooms #4 and 5 are the designated staff rooms. All rooms were free of odors. All window screens were clean and maintained in good repair. There are two (2) bathrooms in the hallway. The resident bathrooms have a shower with non-skid materials. The toilets and showers have grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. CONTINUED ON LIC 809C. Resident/staff records and medications are stored in a locked filing cabinet which is currently located in the kitchen. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a kitchen cabinet. Kitchen knives are stored in a locked drawer in the kitchen. Stove burners are rendered inaccessible to the residents via child proofing knobs. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked shed located in the back yard of the facility. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games and/or activity supplies in the living room and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight were equipped with sturdy hand railings and were well-lighted. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The smoke detector, fire doors, and carbon monoxide detectors were tested and functioned properly during the time of visit. There are two (2) fire extinguishers throughout the house. They are fully charged and do not exceed the expiration date. CONTINUED ON LIC 809C. Hot water was tested in each bathroom in addition to the kitchen; and, the hot water ranged from 108.1 to 111.2 degrees Fahrenheit. The laundry area is located in a locked room attached to the house. The supply of extra bed and bath linens is adequate. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted at the entryway to the facility along with the emergency telephone numbers and other required postings. LPA did not observe a PUB 475 poster located at the facility. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. The entire property is fenced. There is a door w/gate with a self-latching mechanism for persons to enter the front yard. There are ten (10) locked storage sheds in the back yard. There is another house on the property that has it’s own address and is not associated with the facility. There are not any bodies of water on the premises at the present time. COMP III orientation was completed with the applicant during this pre-licensing inspection. The following items must be corrected prior to licensure. Submit proof of corrections, along with a copy of this report, to LPA Byrne so that your application may be completed. The applicant had to leave the facility at the time of the visit. This report was read to the applicant via telephone call. This report was emailed to the applicant and a signature on the emailed copy was requested. This report will be sent to the Centralized Application Bureau (CAB) once all corrections are received. You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. CONTINUED ON LIC 809C. 87468 (c)(2)(A) 87468 Personal Rights (c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20" x 26" in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website.