Pre-licensing visit·January 27, 2026

Licensing Program Analyst (LPA) Quoc Huynh conducted a pre-licensing visit to the above noted facility. At 12:53PM, the LPA met with Applicant Davit Nazaryan. Entrance interview conducted. A Change of Ownership application to operate a Residential Facility for the Elderly was submitted on 09/10/2025. A dementia program was included in the plan of operation. A Hospice Waiver for 6 (six) has been requested. The facility's fire clearance was approved on 10/23/2025 for one (1) bedridden and five (5) non-ambulatory, with a total capacity of six (6) residents. Component II orientation was completed on 01/09/2026. Component III was completed with the applicant during today's visit. Beginning at 12:57PM, a physical plant tour was conducted. The following was observed: BEDROOMS/BATHROOMS: The facility had four (4) bedrooms. Bedroom #4 have a direct access to the outside and is cleared for a bedridden resident. Resident rooms were set up with beds, nightstands, lamps, chairs, sufficient clothing storage and closet space. The beds were furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, and blanket (if needed). Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. Report Continued on LIC 809-C There were three (3) bathrooms: one (1) visitor, one (1) shared, and one (1) private. The bathrooms have a shower with non-slip mats. The toilet and shower have grab bars. The hot water temperature was tested and measured within the required range of 105*F to 120*F. COMMON AREAS: Common areas were appropriately furnished, and the lighting was adequate. There was a television, reading materials, and/or activity supplies in the living room. There was a fireplace that was properly screened. There was sufficient space to accommodate both indoor and outdoor activities. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included but not limited to flashlights. Nightlights were observed throughout the common areas. The facility has central heating and air conditioning to maintain rooms to a comfortable temperature. At 1:26PM, the hardwired combination smoke and carbon monoxide detectors as well as fire doors were tested and functioned properly. The fire extinguisher was fully charged and purchased on 07/07/2025. The supply of extra bed and bath linens as well as personal hygiene items were adequate. Extra supplies, cleaning products, food, and the office were located in the garage. There is a washer and dryer closet located in the hallway and observed to be in good condition. There is a functioning telephone on the premises. All required postings are posted near the entrance of the facility. KITCHEN: Knives were stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at 0*F and the refrigerator was maintained at 40*F. The supply of nonperishable foods and emergency food supply is adequate. Cleaning supplies are stored in a locked cabinet under the kitchen sink. There are no pesticides or toxins stored in any food storage area or preparation area. Appliances in the kitchen were clean and functional. Medication was stored in a locked dining room cabinet. First aid kit was observed to be complete, including a thermometer and a current version of a first aid manual. Report Continued on LIC 809-C OUTDOOR AREA: The exterior passageways were clean and clear of any obstructions. There was a courtyard and rear yard with furniture and shade for resident use. There was one (1) side emergency exit with a self-latching mechanism and the opposing side of the facility was secured with storage. There were no bodies of water on the premises at the present time. No corrections required. Exit interview conducted. A copy of the report was issued. 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.