Pre-licensing visit·November 4, 2025

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit and met with the applicant Anna Hakobyan. This is a new facility application for a Residential Facility for the Elderly (RCFE) for four (4) non-ambulatory residents; one (1) of which may be a bedridden resident. Fire Clearance was approved on 08/14/2025. Bedridden resident is approved in bedroom #3. At 10:05 a.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility will be following Title 22 Regulations. COMMON AREAS: The living room area is equipped with a television, and table games. There is a dedicated area for the posting of required documents in the hallway leading to the bedrooms. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Medications will be stored in a locked cabinet by the main entrance. The residents’ and staff files will be stored in the same closet as the medication closet. LAUNDRY: There is a laundry area equipped with washer and dryer. The washer and dryer are located in the hallway next to bedroom # 2. Detergents and cleaning supplies will be stored in a locked cabinet next to the washer and dryer. An auditory device was observed and heard leading to the backyard. A linen cabinet was observed next to the hallway bathroom, with sufficient supply of extra linen and towels. Continues on LIC 809C... KITCHEN: Kitchen knives are stored locked and inaccessible in a locked kitchen drawer. A seven-day supply of non-perishable food was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 113.4 degrees Fahrenheit. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. A fire extinguisher is located near the main entrance door, which was purchased on 06/25/2025. BEDROOMS: There are three (3) bedrooms for residents in care. Rooms # 1 and 2 will be used as private rooms. Room # 3 is a shared room; all bedrooms are cleared for non-ambulatory. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available. Auditory devices were observed and heard in each bedroom. BATHROOMS: There are two (2) full bathrooms, with shower area. Bathrooms are equipped with toilets and shower grab bars, and non-skid mats. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water delivered was 113.4 degrees Fahrenheit. SURROUNDING GROUNDS/OUTDOOR AREA: The exterior passageways were clean. The patio is furnished with outdoor furniture for residents’ use, and shade is available behind and front of the facility. The building has a central entrance for residents and visitors. The applicant completed Component III orientation. Pre-Licensing is complete. 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. 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. Exit interview was conducted and reviewed with the applicant. A copy of the report was issued.