Pre-licensing visit·May 29, 2026

Licensing Program Analyst (LPA) Angela Barutyan conducted an announced pre-licensing visit to the facility noted above at 10:00AM. LPA met with Administrator/Applicant Mariam “Maya” Kevliyan. The applicants have obtained fire clearance for a total capacity of six (6) residents; five (5) non-ambulatory and one (1) bedridden. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The facility is one story. The facility has five (5) bedrooms total; two (2) are private resident-use, two (2) are shared resident-use, and one (1) is for staff-use. Bedrooms #1 and #4 are cleared for bedridden use and Bedrooms #2 and #3 are cleared for non-ambulatory use. The combination smoke alarm/carbon monoxide detectors were tested and functioned properly. LPA observed fire extinguisher to be fully charged and last serviced on 03/27/2026. LPA toured the kitchen area at approximately 10:04AM. The hot water temperature was measured in the kitchen sink, and it measured at 112.5 degrees Fahrenheit. Appliances and all equipment appear to be clean and in good repair. The kitchen has a sufficient supply of plates, cups, cookware, and utensils. Kitchen knives and sharps are locked in a cabinet drawer. LPA observed the locked garage by the kitchen which contained a washer and dryer, cleaning supplies, toxins, detergents, disinfectants, locked medication fridge, and emergency food and water supply. Report Continued on LIC 809C. Resident bedrooms are equipped with clean mattresses, pillows, and bedding. Bedrooms have sufficient lighting. There is a sufficient supply of linens, including blankets, bath towels, and wash cloths. The facility has three (3) bathrooms total. Bedroom #4 has an attached bathroom, there is one (1) bathroom located in the hallway for staff and residents, and Bedrooms #2 and #3 have a shared Jack-and-Jill bathroom. Bathrooms contained appropriate slip-resistant surfaces and grab bars. Hot water temperature was measured in all bathrooms, and they measured between 105.3-111.4 degrees F, which is within the required range. The living room and dining room are clean and properly furnished. All window screens and coverings are in good repair. Fireplaces in living room and dining room were adequately screened. LPA observed enough seating for six (6) residents at the same time at the dining room table. A working telephone is present. There are activity supplies in the living room. LPA observed additional linens, bedding, and towels in the hallway closets Medications and First Aid Kit were stored locked and inaccessible in cabinet in the dining room. First Aid Kit was observed to have bandages, thermometer , scissors, tweezers, and a current first aid manual. Facility records will be maintained in the dining room cabinet. Cameras were observed inside and outside, with no audio component. Auditory exit alarms in bedrooms and common areas were functioning properly. There will be no firearms/ammunition stored on the property. The facility has required postings, including Emergency Exit Plan, Licensing Complaint Poster, Resident Personal Rights, and Theft and Loss Policy. The exterior passageways were free of obstructions. LPA observed the backyard, which has a covered outdoor area with a table and chairs for resident use. The in-ground pool was fenced and gated. Physical plant is consistent with the submitted facility sketch/floor plan. Comp III conducted with Administrator/Applicant. Pre-Licensing is complete and this facility has no deficiencies. 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 conducted. The report was reviewed, and a copy was provided.