Pre-licensing visit·September 10, 2025

Licensing Program Analyst (LPA) Angela Barutyan conducted an announced pre-licensing visit to the facility noted above at 10:00AM. LPA met with Administrator Sevak Tsaturyan, Applicant Maya Moskovyan, and Applicant Representatives Lusine Tadevosyan and Vahan Aghabekyan. The applicant has obtained fire clearance for a total capacity of six (6) residents. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The facility is one story. The facility has four (4) bedrooms total; two (2) are shared resident bedrooms and two (2) are private resident bedrooms. Three (3) resident bedrooms are cleared for nonambulatory and one (1) bedroom, Bedroom #4, is cleared for bedridden. The combination smoke alarm/carbon monoxide detectors and fire door were tested and functioned properly. LPA observed one (1) fire extinguisher to be fully charged and purchased on 07/02/2025. LPA toured the kitchen area at approximately 10:05AM. The hot water temperature was measured in the kitchen sink, and it measured at 105.1 degrees Fahrenheit. Appliances and all equipment appear to be clean and in good repair. The kitchen has a sufficient supply of plates, cups, cookware, utensils, and non-perishable foods. Kitchen knives and sharps are locked in a cabinet drawer. LPA observed emergency food and water supplies. There is a laundry unit by the kitchen and office area. Additional cleaning supplies, toxins, detergents, disinfectants, and cleaning supplies were stored locked in a hallway closet. Report Continued on LIC 809C. Report Continued from LIC 809C. Resident bedrooms are equipped with clean mattresses, pillows, and bedding. Bedrooms have sufficient lighting. There is a sufficient supply of linens, including blankets, bath towels, and wash cloths. The facility has two (2) bathrooms for resident use; one (1) is in the hallway and one (1) is attached to Bedroom #1. Bathrooms contained appropriate slip-resistant surfaces and grab bars. Hot water temperature was measured in all bathrooms, and they measured between 105.6-105.8 degrees F which is within the required range. The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. LPA observed enough seating for six (6) residents at the same time in the dining room table. A working telephone is present. There are activity supplies in the living room. Night-light was present in the hallway. Medications will be stored and locked in a cabinet by the kitchen as well as facility records and First aid kit. First aid kit was observed to have bandages, thermometer, scissors, tweezers, and a current first aid manual. Cameras were observed outside and in common areas and do not record audio. There will be no firearms/ammunition stored on the property. The facility has required postings, including Emergency Exit Plan, Licensing Complaint Poster, Resident Personal Rights, and Theft and Loss Policy. The exterior passageways were free of obstructions. Emergency side gate was self-latching. There were no bodies of water on the premises. LPA observed the backyard, which has a covered outdoor area with a table and chairs for resident use. There is an accessory dwelling unit (ADU) where staff will sleep. Auditory exit alarms were functioning properly. Physical plant is consistent with the submitted facility sketch/floor plan. Comp III conducted with Applicant and Administrator. Pre-Licensing is complete and this facility has no deficiencies. 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 conducted. The report was reviewed, and a copy was provided.