Pre-licensing visit·November 17, 2025

Licensing Program Analyst (LPA), Zabel Chochian conducted an announced Pre-Licensing visit to the above facility and met with Applicant/Licensee, Kim Hovannisyan. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Fire Clearance was approved on 07/017/2025 for a maximum capacity of six (6) non-ambulatory residents, of which one (1) bedridden residents. Hospice waiver approved for six (6) residents. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: BEDROOMS: There are five (5) bedrooms designated for clients use. All bedrooms are furnished with beds, dressers, chair and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. Hallway night lights observed operable. BATHROOMS: There are two bathrooms, one in resident room #2 and one common bathroom for guest and residents use. LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bars and non-skid mats for the shower. Hot water temperature was measured at 116.5 degrees Fahrenheit. COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The living room and dining area. KITCHEN: The facility Kitchen was toured and observed with operable appliances. Adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6) resident and staff observed. All knives and sharps are to be locked in a kitchen cabinet and inaccessible to residents. Fire Extinguisher was last purchased on 09/2025. appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. MEDICATIONS: The medication and facility staff/resident files will be kept in a locked cabinet located kitchen cabinet. (Continue to LIC809C) SMOKE DETECTORS/CARBON MONOXIDE. Dual smoke and carbon monoxide detectors were located throughout the facility. Smoke detectors observed in each resident room. Detectors were tested and observed to be operational. GARAGE: The washer/dryer observed in the garage; appeared to be in good condition. Laundry supplies are kept inaccessible when not in use. SURROUNDING GROUNDS: LPA observed appropriate outdoor furniture, with a covered shaded area for residents . The backyard is fenced. There is a unit in the back that might be separated with a different address in the future for a new facility. Applicants acknowledged understanding that the back unit may only be used as a recreational room at this time per fire clearance. The exterior passageways were clean and clear of any obstructions. There are no bodies of water on the premises at the time of the visit. Self-latching gate located at the side of the facility. Physical plant is consistent with the submitted facility sketch/floor plan. During today’s visit, LPAs reviewed facility’s program plan, personnel policies, abuse reporting procedures, in-service training protocol, and medication procedures. The physical plant of this facility location is in compliance with Title 22 regulations at this time. Component III Orientation was conducted in conjunction with the visit at 2:30 P.M. 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 with a copy of this report was provided to the Applicant/Administrator.