Pre-licensing visit·October 27, 2025

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility to conduct a Pre-licensing visit. The LPA met a with the Administrator Meri Tarposhyan. This is a new facility application for a Residential Facility for the Elderly (RCFE) for five (5) non-ambulatory residents; one (1) bedridden resident. Fire Clearance was approved on 09/08/2025. Bedridden approved in bedroom #2. At 9:35 a.m., the LPA, and the applicant/administrator 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 living room area is equipped with a television. There is a dedicated area for the posting of required documents at the entrance of the facility. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Medications will be stored in a locked cabinet in the area next to the kitchen. The residents’ and staff files will be stored and locked in the same cabinet as the medications. LAUNDRY: There is a laundry area in the kitchen equipped with washer and dryer. The washer and dryer are behind closed doors. Detergents and cleaning supplies will be stored in a locked cabinet next to the kitchen. The Administrator will add a night light outside bedroom #3. KITCHEN: Kitchen knives are stored locked and inaccessible in a locked kitchen drawer. A seven-day supply of non-perishable food was observed however, Administrator will purchase 7-day supply of water, and additional non-perishable supplies. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Continues on LIC 809C..., Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 118.5 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 near the backdoor exit, which was purchased on 07/02/2025 (Administrator will print receipt and will attach to the fire extinguisher). BEDROOMS: There are three (3) bedrooms for residents in care. All rooms will be shared rooms. All bedrooms are cleared for non-ambulatory and bedroom #2 is cleared for one (1) bedridden resident. All the bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available, however bedroom’s #1, 2 and 3 need to have the closet re-arranged to make room for second resident’s personal belongings, the current residents in rooms #1 and #3 are using all the closet space. Additionally, all three bedrooms need to have the television mounted on the wall to clear the passages in the bedrooms, as they currently sit on a T.V. stand, which restricts the passage in the bedrooms. Bedroom’s #2 smoke alarm is detached from the ceiling unit and is hanging from a wire. 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 118.8 degrees Fahrenheit. The Administrator will add locks to the bathroom sink cabinets, to be able to store grooming essentials. Continues on LIC 809C... SURROUNDING GROUNDS/OUTDOOR AREA: The exterior passageways were cleared of obstructions. However, there are some items that need to be removed: Two small paint cans, two open bags of cement, and trash materials. 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 for bedridden exit. An auditory device will be installed to monitor the exit gate, and a self-latch lock will be added. Pre-Licensing is incomplete with deficiencies to be resolved by 11/05/2025. Follow up Pre-licensure LIC809 will be generated upon resolution. 1. The Administrator will add a night light outside bedroom #3. 2. Administrator will purchase 7-day supply of water, and additional non-perishable supplies. 3. Administrator will print fire extinguisher purchase receipt and will attach it to the fire extinguisher. 4. Bedroom’s #1, 2 and 3 need to have the closet re-arranged to make room for second resident’s personal belongings, the current residents in rooms #1 and #3 are using all the closet space. 5. All three closets need a divider to separate residents’ clothes. 6. All three bedrooms need to have the television mounted on the wall to clear the passages in the bedrooms, as they currently sit on a T.V. stand, which restricts the passage in the bedrooms. 7. Add stickers to touch lamps to make it easy to find the on/off area. 8. Bed in room #2 needs screws to be tightened by the footboard area. 9. Bedroom’s #2 smoke alarm is detached from the ceiling unit and is hanging from a wire. 10. Bedroom #2 need to an oxygen machine removed from closet. 11. Bedroom #2 needs to have big chair switched with a smaller chair. 12. Bedroom #2 closet currently has all bedrooms’ linens in this closet. 13. The Administrator will add locks to the bathroom sink cabinets, to be able to store grooming essentials. 14.Need to be removed outdoors: Two small paint cans, two open bags of cement, and trash materials At 2:06 p.m. 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.