Routine inspection·September 10, 2025

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was let into the home by Karine Khojikyan, Staff. Armenui Arzumanyan, Administrator was contacted by staff and she arrived at 10:20am to conduct the visit. The reason for today's visit was explained. The facility is a single storey home located in the back of the property consisting of 2 separate buildings with separate addresses. The home consists of a living room, dining room, kitchen, a den, 5 bedrooms and 4 full bathrooms. No bodies of water were observed on the premises. The facility is fire cleared for 5 NON- AMBULATORY and 1 BEDRIDDEN resident. Bedroom #3 is designated for bedridden use. On today's visit, LPA Yee reviewed the entire CARE Inspection Tool, 6 Resident and 6 Staff files, Plan of Operations, Disaster Preparedness and Infection Control Plan. The following was observed on today's visit: the living room was observed furnished with a sofa, love seat, a desk, a built in bar, chairs and filing cabinets for staff and resident files behind the bar. The family room was observed with plenty of sitting, a dining table and 6 chairs, a fire place that was secured with a glass door and a fire screen. continued on LIC809-C Page 2 the kitchen is equipped with the usual stove, dishwasher, oven and refrigerator. Food supply was reviewed in the pantry, refrigerator and the outside refrigerator, there was sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed. A recommendation was made to supplement the canned proteins with additional cans of chicken and fish. Located inside the panty is the only fire extinguisher purchased on 6/30/25. Bedrooms #1, #2, #4 and #5 were each furnished with a hospital bed, a night stand, a lamp, a chair, a dresser and a built in closet except for bedroom #5. Bedroom #5 has a portable closet. Bedroom #3 was observed with 2 hospital beds, 2 night stands, 2 chairs, 2 lamps and a walk in closet. a shared dresser. The auditory device on the door was tested and was operational. Located inside bedroom #2, #3 and #4, all have a private bathroom. The bathrooms located inside bedroom #2 and #4 contained a walk in shower, a shower chair, grab bars, a slip resistant mat, a toilet with a riser. Water temperature was tested and read 115.4 in bedroom #2 and 118.6 in bedroom #4. Bedroom #3 was observed with a walk in shower, a toilet with a riser, a bidet, grab bars, a slip resistant mat, 2 sink vanity and a jacuzzi bath tub. Water temperature read 115.5 degrees Fahrenheit. the common bathroom was observed with a walk in shower, chair, grab bars, a slip resistant mat, a single sink vanity, a toilet. Water temperature was tested and read 118.1 degree Fahrenheit. the first aid kit and manual met Title 22 requirements. the hardwired smoke detectors located inside the 5 resident rooms, hallway, living room an family room were tested and were operational. Per test, the combination smoke/carbon monoxide detectors are located in the hallway and living room. The fire rated doors for bedroom #1 and the hallway were operational. the auditory devices on the outside exiting doors in the living room, family room, bedroom #1 and bedroom #3 were operational. the facility has current general liability insurance that meets Title 22 requirements. centrally stored medications a re stored in locked cabinets in the kitchen Cleaning solutions, disinfectants and toxins are stored in a locked cabinet in the laundry area and in a locked cabinet under the kitchen sink. knives are stored in a locked case inside a kitchen drawer. continued on LIC809-C Page 3 Per tour of the outside areas, a covered patio furnished with wicker chairs, storage cabinets and a refrigerator was observed. The outside areas were observed to be clean. The trash cans are stored in the front by the gate. Per Administrator, new trash cans were ordered and are pending delivery. No deficiencies were cited on today's visit.