Pre-licensing visit·June 21, 2024

Licensing Program Analyst (LPA) Mariana Agban conducted a Pre-Licensing Inspection with facility Administrator Zaruhi Harutyunyan. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on March 08,2024. A fire clearance was approved on April 18, 2024 for a maximum capacity of five (5) non- ambulatory adults, one(1) Bedridden adult. Hospice waiver has been approved for six (6) hospice residents. A tour of the physical plant was initiated at 9:35am and the following was observed: The smoke alarms and carbon monoxide detector are hard wired and inter-connected. Fire extinguisher purchase date is 03/22/24. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6) residents. BEDROOMS: There are four (4) bedrooms designated for residents use. Two (2) bedrooms are designated to be shared rooms and two (2) bedrooms are designated to be private use . All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space. Each bedroom had wearable lanyard emergency/ caregiver call button. BATHROOMS: The facility has one (1) main bathroom in the main hallway and one (1) in the bedroom #4 for the residents in that room to utilize. The hot water delivered in the bathroom sink was measured at 107.8 and 106.2 F. COMMON AREAS: These included the living room and dining room, which were equipped with furniture, a television, sofa. There is electric fireplace in the living room. It is non-operational. No fireplace tools or fixtures present. The auditory alarms on all exit doors were on and functional at the time of the visit. Laundry Area/ Garage: The washer/dryer appear to be in good condition. The laundry room will kept locked. Laundry cabinets was locked and thus laundry detergents are inaccessible to residents. LPA observed extra storage cabinets in the garage. MEDICATION: The medication will be kept in a locked in the kitchen cabinet. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. (Continue 809C) There is a car port large enough to park two cars. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space. There is no swimming pool or bodies of water. The side gate was checked to insure it was clear of obstruction. Staff and resident files: Staff and resident files will be kept and maintained in a locked cabinet in the living room. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.