Pre-licensing visit·November 17, 2025

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit and met with the applicants Sussan Amirkhanyan and Mariam Petrosyan. This is a new facility application for a Residential Facility for the Elderly/Dementia (RCFE) for six (6) non-ambulatory residents; one (1) of which may be a bedridden resident(s). The Applicant applied for five (5) hospice waivers. Fire Clearance was approved on 08/18/2025. Bedridden resident approved in bedroom #3. The LPA, and the applicants 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 located in the hallway between bedrooms #1 and #2. The residents’ and staff files will be stored and cabinets will be stored in a file cabinet located in the hallway. LAUNDRY: There is a laundry area equipped with washer and dryer. The washer and dryer are located in the kitchen area. Detergents and cleaning supplies will be stored in a locked cabinet under the sink. 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 116.6 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 in the kitchen area next to the refrigerator, which was purchased on 08/17/2025. Continues on LIC 809C.. BEDROOMS: There are three (3) bedrooms for residents in care. All bedrooms are shared bedrooms. Room #3 is approved for one (1) bedridden resident. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available. The closets in all three bedrooms will require a divider to ensure private space for each resident’s clothes. Currently all beds are set up with the required linens, however the applicant will purchase additional extra comforters BATHROOMS: There are two (3) full bathrooms, with shower area. 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 116.5 degrees Fahrenheit. One bathroom is located in the hallway between bedroom #1 and #2. The second bathroom is located inside bedroom #3. At the time of the visit the LPA noted that the bathroom sink is too close (17”) from the shower area, restricting the passage of the resident to the sink for the resident residing in bedroom #3. The two bathrooms need a shower curtain. 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. At the time of the visit the LPA observed one (1) ADU unit. The unit is identified by address #7343 and is located on the left-hand side of the facility. The ADU unit is attached to the main address but is not accessible from inside the facility address: #7341. The Fire inspection report did not mention the ADU. The fire inspection report does not add whether the ADU was part of the inspection. The Applicant will reach to the CAB analyst to request a second fire inspection. Pre-Licensing is incomplete with deficiencies to be resolved by .... Follow up Pre-licensure LIC809 will be generated upon resolution. 1. The Applicant will reach to the CAB analyst to request a second fire inspection. 2. The bathroom sink will need to be adapted to allow passage to the resident in Bedroom #3. 3. Outdoor shed will need a padlock installed. 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.