Pre-licensing visit·May 28, 2025

Licensing Program Analysts (LPAs) Quoc Huynh and Kelly Dulek conducted a pre-licensing visit to the above noted facility. At 11:00AM, the LPAs met with applicant, Kajo Movsesian. An application to operate a Residential Facility for the Elderly was submitted on 10/18/2024. A dementia program was included in the plan of operation. A Hospice Waiver for 6 (six) has been requested. The facility's fire clearance was approved on 01/22/2025 for two (2) bedridden and four (4) non-ambulatory, with a total capacity of six (6) residents. Component II orientation was completed on 05/01/2025. Component III was completed with the applicant during today's visit. The facility is a single-story home located in Van Nuys. Beginning at 11:05AM, a physical plant tour was conducted. The following was observed: BEDROOMS/BATHROOMS: The facility has four (4) bedrooms. Bedrooms #1, #3, and #4 have a direct access to the outside and is cleared for bedridden residents. Resident rooms are set up with beds, nightstands, lamps, chairs, sufficient clothing storage 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, and blanket (if needed). 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. All rooms were free of odors. All window screens were clean and maintained in good repair. Report Continued on LIC 809-C There are two (2) bathrooms, both shared. The bathrooms have a shower with non-slip mats. The toilet and shower have grab bars. The hot water temperature was tested and measured within the required range of 105*F to 120*F. COMMON AREAS: Common areas were appropriately furnished, and the lighting was adequate. There is a television, reading materials, and/or activity supplies in the living room. There is a fireplace that was properly screened. There was sufficient space to accommodate both indoor and outdoor activities. 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 but not limited to flashlights. Night-lights were observed throughout the common areas. The facility had emergency food and water available. The facility has central heating and air conditioning to maintain rooms to a comfortable temperature. At 12:33PM, the hardwired combination smoke and carbon monoxide detectors were tested and functioned properly. The fire extinguishers throughout the facility were fully charged and purchased on 05/24/2025. The supply of extra bed and bath linens as well as personal hygiene items were adequate. Extra incontinence supplies and other supplies are located outside in the locked storage shed. There is a washer and dryer closet located in the hallway and observed to be in good condition. There is a functioning telephone on the premises. All required postings are posted near the entrance of the facility. KITCHEN: Knives are stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit and the refrigerator was maintained at 40*F. The supply of nonperishable foods and emergency food supply is adequate. Cleaning supplies are stored in a locked cabinet under the kitchen sink. There are no pesticides or toxins stored in any food storage area or preparation area. Appliances in the kitchen were clean and all appeared functional. Medication will be stored in a locked kitchen cabinet. Report Continued on LIC 809-C Files will be stored in a separate locked kitchen cabinet. First aid kit was observed to be complete, including a thermometer and a current version of a first aid manual. OUTDOOR AREA: The exterior passageways were clean and clear of any obstructions. There are two areas at the back of the house with tables and chairs where residents can sit. The outdoor space is property gated. There are two storage sheds in the back yard intended for extra supplies. There are no bodies of water on the premises at the present time. No corrections required. Exit interview conducted. A copy of the report was issued. 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.