Pre-licensing visit·June 12, 2025

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit and met with the Applicant Gevork Kharatian. This is a new facility application for a Residential Facility for the Elderly (RCFE) for six (6) non-ambulatory residents; one (1) of which may be a bedridden resident(s). Fire Clearance was approved on 05/01/2025. Bedridden was approved in either bedroom #1 or #2. At 10:45 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 common areas include the living room area, dining room area and sun room. The living room area is equipped with appropriate furniture. There is a dedicated area for the posting of required documents at the entrance of the facility and the wall between bedroom #2 and the sun room sliding door. The Applicant will obtain a CCL Poster (If You See Something, Say Something) that meets the department’s size regulation and will replace the current poster. The poster will be place by the entrance door next to the Ombudsman poster. 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 foyer area. The residents’ and staff files will be stored and locked in a file cabinet located in the storage room next to the kitchen. The fireplace was observed to be non-functional and covered with a fire screen that is bolted to the wall. LAUNDRY AREA: T he washer and dryer are located in a storage area located adjacent to the kitchen area. Detergents and cleaning supplies will be stored on a shelf on top of the washer and dryer. 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 118.6 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 next to the dining room table. The fire extinguisher was purchased on 06/12/2025. BEDROOMS: There are three (3) bedrooms for residents in care. Rooms # 1 was approved as a shared room for two (2) ambulatory residents. Room #2 was approved as a shared room for one (1) bedridden resident, and one (1) non-ambulatory. Room # 3 was approved as shared bedroom for two (2) non-ambulatory residents/ and or a bedridden resident. All bedrooms were supplied with all required linens. There is sufficient lighting. The following deficiencies will be corrected per the Applicant: Bedspreads/comforted for all beds. A minimum of eight cubic feet of drawer space will be provided for all bedrooms. Smaller night stands will be purchased to allow for ample room in bedrooms #2 and #3. Chairs for all bedrooms are on route to be delivered. BATHROOMS: There are two (2) full bathrooms. 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 at 119.6 degrees Fahrenheit. The following deficiencies need to be corrected: Install mirrors in both bathrooms, hand washing signs posted, one shower chair, one trash can with cover. SURROUNDING GROUNDS/OUTDOOR AREA: The exterior passageways were clean. The patio is furnished with outdoor furniture for residents’ use, and shade is available. The building has a central entrance for residents and visitors. Right passageway is cleared and has a self-latching gate. The self-latching mechanism is located on the outside of the gate facing the street. There is a crawl space located on the left -hand side of the exit sun room door leading to the patio. Deficiency: The crawl space needs a cover that is flushed and covers the opening of the crawl space, so that it does not become a danger to residents in care. Area to be cleared of spider webs. Continues on LIC 809C... ADMINISTRATION: Emergency exiting plans need to be created and posted. Re-do floor plan and send to CAB to be updated. Pre-Licensing is incomplete with deficiencies to be resolved by 06/19/2025. Follow up Pre-licensure LIC809 will be generated upon resolution. · The Applicant will obtain a CCL Poster (If You See Something, Say Something) that meets the department’s size regulation and will replace the current poster. · Bedspreads/comforted for all beds. A minimum of eight cubic feet of drawer space will be provided for all bedrooms. Smaller nightstands will be purchased to allow for ample room in bedrooms #2 and #3. Chairs for all bedrooms. · Install mirrors in both bathrooms, handwashing signs posted, one shower chair, one trashcan with cover. · The crawl space needs a cover that is flushed and covers the opening of the crawl space, so that it does not become a danger to residents in care. Area to be cleared of spiderwebs. · Emergency exiting plans need to be created and posted. The applicant completed Component III orientation. 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.