Pre-licensing visit·May 29, 2025

Licensing Program Analyst (LPA) Christine Yee conducted an announced Prelicensing and Component III visit to ensure that the home met Title 22 requirements. The CARE Inspection Tool was used on today's visit. LPA Yee met with Mane Gevorgyan, Applicant. The home is a single storey family home consisting of a living room, dining room, kitchen, 3 bedrooms and 2 full bathrooms. Located in the back of the home is a detached garage. The home is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #1 and Bedroom #2 are approved for bedridden use. The following was observed on today's visit: The living room is furnished with a sofa for 4 residents and a chair, coffee table, a side table, 2 end tables and a television. An additional chair will be added by the applicant. The fireplace was observed with a fire screen. The dining room is furnished with a table, 6 chairs, a desk and a locked filing cabinet. The kitchen is equipped with a stove, refrigerator, dishwasher and a microwave Sufficient dinner plates, salad plates, soup bowl, cups, glasses and utensils for 6 residents were observed. Pots and pans for making meals were observed. Medications will be stored in a locked cupboard, sharp knives stored in a locked drawer and dish soap stored in the locked cabinet beneath the kitchen sink. Sufficient non-perishable foods for a minimum of 7 days were observed on the premises. Perishable Page 2 foods for a minimum of 2 days will be purchased and maintained on the premises prior to accepting the first resident The only fire extinguisher, purchased on 3/11/25 is mounted in the dining room. All three bedrooms were observed with 2 twin beds, 2 night stands, 2 lamps, 2 chairs and a built in closet. Bedroom #3 has a 4 drawer dresser. Window dressing were observed on the window and sliding glass doors. An extra curtain panel on the sliding glass door is needed in bedroom #2 for privacy. All the required bed linens and a pillow was observed on the beds. Extra set of linens and blankets and 13 sets of towels were observed in the cupboard located in the living room. Hygiene products, cleaning solution, laundry detergent were observed in the locked closet located in the living room. Little flash rights were observed on the night stands night light was observed in the hallway. The laundry closet located by the bedroom #1 was observed with a washer and dryer. A first aid kit and first aid manual was observed. The first aid kit needs a tweezer. The hardwired smoke alarms located inside the 3 bedrooms and the only combination smoke/carbon monoxide detector located in the hallway were tested and were operational. The required postings were observed. A laptop was observed for resident use The private bathroom located inside bedroom #2 was observed in a walk-in shower, a toilet, a bath tub, and a single sink. A slip resistant mat and grab bars were observed in the shower and behind the toilet. Grab bar is needed for the bath tub. Water temperature was tested and read 112.1 degrees Fahrenheit The common bathroom was observed with a walk-in shower, a toilet and a sink. A slip resistant mat and grab bars were observed in the shower and behind the toilet. The water temperature was tested and read 111.1 degrees Fahrenheit. The back and front yard was toured. The back has a covered patio with table and plenty of chairs for resident activities. Trash cans were observed to be tightly sealed along the garage. Page 3. The back and front yard was observed to be clean and well maintained. The garage was toured and had some items stored inside. However, the garage will be primarily used for parking. The following needs to be corrected prior to licensure: dressers are needed in bedroom #1 and #2 a tweezer needs to be placed in the first aid kit. a grab bar needs to added for the bath tub in the private bathroom an extra curtain panel needs to added in bedroom #2 for privacy The following will need to be completed upon licensure: purchase general liability insurance with limits of $1 million per occurrence and $3 million total annual aggregate. purchase perishable foods for a minimum of 2 days prior to accepting the first resident create files for residents, staff and volunteers Component III was conducted with Mane Gevorgyan, Applicant during this visit. The Applicant will notify LPA Yee once the corrections have been completed. Exit interview was conducted.