Pre-licensing visit·June 30, 2025

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Lousine Sarkisian. 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 10:23 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 resident bedrooms, rooms #1 & 3 and two (2) shared rooms, rooms #2 & 4. Bedroom #3 is the approved bedridden room and contains a direct exit to the outdoors of the facility. 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 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. There are no staff bedrooms at the facility awake night staff are required. All rooms were free of odors. All window screens were clean and maintained in good repair. There are two (2) shared bathrooms in the hallway and one (1) private bathroom attached to bedroom #3. The resident bathrooms have a shower with non-skid materials. Grab bars were observed near all resident toilets and near all resident showers. All were properly secured. 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 and staff records are stored in a filing cabinet which is currently located in the Administrator’s office. Medications are centrally stored in a locked hallway closet. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a locked hallway closet. Kitchen knives are stored in a locked drawer in the kitchen. Stove burners are rendered inaccessible to the residents by removing them when not in use. 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 and house cleaning supplies are stored in a locked under sink cabinet located in the kitchen. Additional laundry chemicals and cleaning supplies are stored in a locked shed located on the outdoors 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 made inaccessible to residents unless equipped with sturdy hand railings and unless 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. There is a fireplace in the living room. It is sealed off and there are no tools. 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, or other battery powered lighting, 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 facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There is one (1) fire extinguisher throughout the house. It was fully charged and did not exceed the expiration date. Continued on LIC 809C. Hot water was tested in each bathroom, which included the resident bathrooms in addition to the kitchen; and, the hot water ranged from 108.3 to 117.3 degrees Fahrenheit. The laundry area is located in an outdoor shed of the facility. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in a locked storage closet along with Extra incontinence. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted in all resident rooms. The emergency telephone numbers along with other required postings are posted in the dining area. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the front of the house with tables and chairs where residents can sit. The entire property is fenced. There is a door w/gate for persons to enter the front yard. There is a locked storage shed in the back yard. There is an ADU on the property, that is separated and not associated with the facility. There is a small fountain in the front yard of the facility. COMP III orientation was completed with the applicant during this pre-licensing inspection. During today’s inspection LPA obtained a copy of the facility’s current liability insurance. 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.