Routine inspection·October 7, 2025

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced annual required visit and inspection of the facility. LPA met with Tina Arutyunyan - Administrator and explained the reason for the visit. The facility is licensed to serve six (6) non-ambulatory residents, of which (1) may be bedridden. Facility has an approved waiver for (4) hospice residents. At 10:45am, with the assistance of Administrator, LPA took a tour of the physical plant. The facility is a one story structure with six (6) bedrooms, two (2) bathrooms, kitchen, dining room, living room and office area. Required postings were observed in the office area. The smoke/carbon monoxide detectors are hardwired and interconnected. At 11:05am smoke/carbon monoxide detectors were tested and observed to be functional. The fire extinguisher is located in the hallway and was purchased on 09/25/2025. Facility conducts quarterly fire drills, the last fire drill was done on 10/05/2025. The auditory alarms on all exit doors were functional at the time of the visit. Common Areas : These included the living room and dining room. There is a television set, gaming area and a covered fireplace in the living room. The common areas were properly furnished with tables and chairs for the number of residents. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. Chemicals and detergents were stored in a locked cabinet in the hallway, next to the living room. Knives were stored in a kitchen drawer but LPA observed a small scissors and a large, sharp knife in a drawer. Staff immediately removed and locked the sharp objects; a citation will be provided. Continued on LIC809-C Bedrooms: There were six (6) bedrooms, five (5) of which are designated for residents' use. Currently bedroom #2 is vacant. Bedroom# 6 is designated as staff room. All bedrooms are were properly furnished with appropriate beddings, chairs, cabinets, linens and have sufficient lighting. Bathrooms: There are two (2) bathrooms, one near the office and one across from bedrooms #2 and #3. LPA observed functional fixtures, grab bars and non-skid mats in each bathroom. Hot water temperature was measured at 107.2 and 112.6 degrees Fahrenheit. Surrounding Grounds: There were no bodies of water present. Pathways and exits were free of obstructions. There is a patio table with umbrella and chairs, in the backyard. There is a two car attached garage, which is currently used for storage. There are two exits near the office, both clearly marked with exit signs. The side exit, near the office has a ramp leading to the side street and is used as the main exit during emergencies. Laundry Room: A stacked washer/dryer was observed next to bedroom #2. Chemicals and detergents were locked in a cabinet in the hallway. Resident Files/Medications : LPA reviewed files for all five (5) residents for required documents. LPA observed the medications stored in a locked cabinet in the living room. Medications for three (3) residents were counted for accuracy of administration. LPA observed a complete first aid kit and the manual in the office cabinet. Staff Files : LPA also conducted a file review of staff records to insure forms and training are up to date and in compliance with licensing requirements. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were cited and appeal rights provided during the visit. Exit Interview conducted / A Copy of the Report Issued to the Administrator.