Pre-licensing visit·July 2, 2025

Licensing Program Analyst (LPA) Christine Yee conducted an announced Prelicensing and Component III visit to ensure that the home met Title 22 requirements. LPA Yee met with Kristine Abasyan, Designated Applicant and Ripa Tavitian, facility's Consultant, who was assisting with today's visit. Hermine Nshanian, Designated Administrator was not feeling well and was not able to join in today's visit. The home is a single storey family home consisting of a living room, dining room, a kitchen, 4 resident bedrooms, 3 bathrooms and a attached garage. The home is fire cleared for 5 non-ambulatory and 1 bedridden resident. Bedroom #4 is the room designated for bedridden use. On today's visit all domain's of the CARE Inspection Tool were reviewed except for the Physical Plant and Environmental Safety domain. The Plan of Operations, Infection Control and Emergency Disaster Preparedness Plan were reviewed. A return visit will have to be scheduled to complete the last domain and to conduct the Component III visit. The following was observed on today's visit: The living room was furnished with 2 sofas, 2 love seat, arm chair, a metal filing cabinet for centrally stored medications and a smaller filing cabinet for other use. Also located in the living room was a desk with a monitor and a printer and a television. The blinds on the living room window are warped and the blinds on the sliding glass door are missing slates. Cobwebs were observed on the ceiling and in the corners were cleaned during the visit. Page 2. A fire extinguisher purchased on 9/24/24 was mounted in the living room and one in the attached garage. The dining room was furnished with a table and 6 chairs. Bedroom #1 was toured and observed with 1 hospital bed with full bed rails,a night stand, a lamp, a chair, a chest of drawers that don't meet the 8 cubic feet requirement and a built in closet. The front corner of the left wall was scratched and needs to be painted. The slate on the top of the window blinds need to be secured. The bed was observed with a mattress cover, a fitted sheet and a throw blanket. Observed in the closet were 10 pillow cases, 5 fitted sheets and 4 bath towels. No flat sheets, twin blankets, comforter, hand towels or face towels were observed. Located inside Bedroom #1 is a private bathroom equipped with a shower stall, a shower chair, a grab bar, a slip resistant mat and a toilet riser handle. The water was tested and read 105.6 degrees Fahrenheit. The first aid kit was reviewed and contained the required supplies, including a pair of scissors, a tweezer and a thermometer There were no files created for the residents and staff under the new ownership. The facility has internet and a tablet for resident's use was observed. The facility tour was ended due to many deficiencies noted. Additional inspection is needed for Bedroom #2 and a complete inspection is needed for Bedroom #3 and Bedroom #4. Outside areas also need to be toured. As of today's visit the following deficiencies were observed and need to be addressed: the facility sketch needs to be updated to reflect the assembly point all full bed rails need to be removed, unless the residents are on hospice and the care plan addresses the use of full bed rails. the Emergency Preparedness Plan needs to be updated to provide plan details instead of general statements The rights of Family council and a current 2025 Labor poster needs to be posted. The Admission Agreement needs to be updated to include the facility's policy on firearms. Bedroom #2, designated for double occupancy was observed with a single bed with full bed rails. Additional beds need to be purchased for a total of 6 residents. The visiting hours need to be posted . Page 3 A subsequent visit is needed to complete the Prelicensing and Component III visit. Corrections of the deficiencies observed today will be reviewed on the return visit. Anything that is not addressed on today's visit will be addressed on the return visit. Exit interview was conducted. .