Routine inspection·September 12, 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 Simonyan, Staff. Vahe Mkrtchian was contacted by staff and he arrived at 10:15am to conduct the visit. The reason for today's visit was provided. The facility is a single storey home consisting on a living room, a kitchen, a dining room, 5 bedrooms, 3 full bathrooms and a detached garage located at the back of the property. Part of the garage has been converted to an office and part of the garage is used for storage. The facility is fire cleared for 5 non-ambulatory and 1 bedridden. However, at the request of the Licensee, the facility is licensed for a total of 4 residents of which 1 may be bedridden. Any of the resident bedrooms may be used for the bedridden resident. On today's visit all 12 domains of the CARE Inspection Tool was reviewed, 4 Resident and 5 staff files were reviewed. Also reviewed were the Plan of Operations, Disaster Preparedness Plan and the Infection Control Plan. The following were observed on today's visit: The living room, dining room, kitchen were all furnished with the appropriate furniture and equipment for it's designated use. continued on LIC809-C Page 2 Bedrooms #1 - Bedroom #4 were all observed with 1 each of the following: a hospital bed, a chair, a night stand, a lamp, a dresser and a built in closet. All 4 bedrooms have an outside exiting door. Auditory devices were mounted on the doors and an announcement with the room number is made in the kitchen when the doors are opened. Located inside Bedroom #4 is a private bathroom equipped with a walk in shower, a shower chair, a toilet, a sink, grab bars and a slip resistant mat. Water temperature was tested and read 117.1 degrees Fahrenheit. Located by the front door is the bedroom for 2 live in staff. It is furnished with 2 beds, dressers and various personal belongings. Located by Bedroom #3 is the staff bathroom equipped with a walk in shower, chair, toilet, a sink, grab bars and slip resistant mat. Water temperature was tested and read 118.6 degrees Fahrenheit. The common bathroom was observed with a walk in shower, a chair, a sink, a toilet, grab bars and slip resistant mats. Water temperature read 118.7 degrees Fahrenheit. Medications are stored in the locked closet by the front door. Sufficient perishable foods for a minimum of 2 days and non-perishable foods for 7 days were observed. however a recommendation was made for the Administrator to purchase actual breakfast foods. Eighteen, one gallon bottles of water was observed, in addition to 3 full packages of 24, 16.9 oz bottles of water. Facility has current general liability insurance that meets Title 22 requirements and a Surety Bond for $11 K. First Aid Kit and first aid manual was observed and met Title 22 requirements. The hardwired smoke detectors located in the resident rooms, staff room, living room and hallways were tested and were operational. The only combination smoke/carbon monoxide detector is located in the resident room hallway. The only fire extinguisher is located in the dining room and was purchased on 4/9/25 Per tour of the outside areas, the backyard has a gazebo furnished with a table and chairs for outside activities. The garage is used for storage of extra wheelchairs and furniture and part of the garage is used as an office. The trash cans stored behind the garage/office were observed to be tightly sealed. continued on LIC809-C Page 3 The front yard was observed to be clean and well maintained. The Administrator will return the empty oxygen tanks store in the garage and advise LPA Yee when done. No deficiencies were cited on today's visit. Exit interview was conducted and copy of the report was provided.