Pre-licensing visit·December 22, 2025

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit and met with the applicant Anna Hayrapetyan. This is a facility application for a Residential Facility for the Elderly (RCFE) for a capacity of six (6) residents: One (1) ambulatory; four (4) non-ambulatory, and one (1) bedridden resident. Bedrooms #1 & #2 are approved for non-ambulatory and bedroom #4 is approved for bedridden a resident, and bedroom #3 for Ambulatory only. Waiver/granted for hospice care for six (6). Fire Clearance was approved on 09/24/2025. At 10:25 a.m., the LPA, and the Applicant 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, and a fireplace which has a cover and is permanently attached. There is a dedicated area for the posting of required documents. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Medications will be stored in a locked rolling cabinet located in the common area. The residents’ and staff files will be stored in a cabinet located in the dining area. LAUNDRY: There is a laundry area equipped with washer and dryer. The washer and dryer are located in a locked room which also has a restroom with a shower adjacent to the kitchen. Detergents and cleaning supplies will be stored in a locked chest outside the kitchen area. Continues on LIC 809C... KITCHEN: Kitchen knives are stored locked and inaccessible in a locked kitchen drawer. A seven-day supply of non-perishable food was availHot water temperature was recorded at 113.5 degrees Fahrenheit. Trash can is in a cabinet compartment next to the sink area. 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, and was purchased on 12/22/2025. BEDROOMS: There are four bedrooms in total. Bedrooms #1 & #2 are approved for non-ambulatory and bedroom #4 is approved for a bedridden resident. Bedroom # 3 is approved for ambulatory only. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting. Bedroom #1 requires additional drawer space and a closet divider to keep residents’ clothes separated from each other. Bedroom # 2 needs additional drawer. BATHROOMS: There is a total of three (3) bathrooms. Two (2) full bathrooms with showers, and one (1) bathroom with a shower and bathtub. 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 at 113.5 degrees Fahrenheit. 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. Left passageway is cleared and has a self-latching gate. The self-latching mechanism is located on the outside of the gate facing the street. Pre-Licensing is incomplete with deficiencies to be resolved by 12/26/2025. Follow up Pre-licensure LIC809 will be generated upon resolution. 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. The applicant will email the CAB analyst a revised floor sketch to reflect the correct numbers of each bedroom according to the approved inspection by the fire Department Inspector. Additionally, the Applicant will submit with sketch reflecting the staff bedroom and laundry room with bathroom. Exit interview was conducted and reviewed with the applicant. A copy of the report was issued.