Pre-licensing visit·April 2, 2025

On 4/02/2025, at 10:00 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an announced Pre-licensing visit. LPA Segovia met with Administrator Ani Akoubian. An application was submitted to Community Care Licensing Division-CCLD on 01/25/2025, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The requested capacity is for five (5) non-ambulatory and one (1) bedridden, a total of up to six (6) residents. The fire clearance was approved on 12/31/2024. Structure: The facility is a single-story building with four (4) bedrooms and two (2) bathrooms. No designated staff room was observed to be located within the facility. Entrance: Upon entrance, required postings such as: Personal Rights of Residents, Rights of Resident by Council, Family Council, Facility Sketch, Non-discrimination Policy and See Something Say Something were observed. Common Areas: The common areas include: the living room, the dining room, and staff reception area. The rooms were observed to be neat, clean, and organized with sufficient seating for both residents and staff. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature of seventy (70) degrees. No firearms were observed or will be maintained on the premises. LPA observed a working telephone to be located in both the living room and staff reception area. Resident/staff files: The resident and staff files will be kept in the staff reception area located near the dining room. Files will be kept in a locked cabinet inaccessible to Residents. LPA observed a complete First-aid kit not limited to tweezers, bandages, digital thermometer, scissors, and first aid manual. LIC809C-continued Medications: The medication will be stored in a locked cabinet along with resident and staff files. Medication storage was observed to be equipped with a lock to ensure medications will not be accessible to residents. Kitchen: The kitchen was observed to be equipped with sufficient supplies of dishes, cups, and silverware located within the kitchen cabinets and drawers. Sharps were observed to be stored in kitchen drawer locked and inaccessible to the residents. The cleaning solutions and toxins were observed to be kept lock in cabinet underneath the kitchen sink. Sufficient supply of food such as: canned goods, bottles of water, cereal were observed in the kitchen pantry. Kitchen appliances were observed to be working and in proper condition. Emergency: The Fire extinguisher was observed to be located near the kitchen and dated 6/13/2024. Bedrooms: The bedrooms were observed to be properly furnished with bed, nightstand, applicable lighting, and seating. Window coverings were observed to be in good repair, not broken or damaged. LPA observed a signal system in each bedroom’s emergency exit doors, working and in proper condition. Bathroom: The bathrooms were observed to be in proper condition and the Administrator will equip the bathrooms with sufficient personal hygiene for each resident upon arrival. Towels and washcloths will not be shared. Appropriate grab-rails and slip-resistant mats were observed and in proper condition. Hallways: The hallway was observed to be properly lighted. LPA observed extra linens/covers stored in cabinet within the hallway’s passageway. Laundry: The laundry was observed to be located aside the kitchen leading towards the bedrooms. Dryer and washer were observed to be in good repair. The Garage: The garage cannot be accessed from inside the facility. The garage was observed located in the front of the facility and kept locked. The garage will be used for extra storage, cleaning solutions, Laundry detergents, extra food for emergencies, and extra personal hygiene supplies. LPA observed an extra freezer working and in proper condition. Office: LPA observed staff reception office located near the dining area. Water Temperature: The water temperature was measured in the bathrooms and observed to be within regulations. LIC809C-continued Smoke detectors: The smoke detectors and carbon monoxide were observed to be working properly and were tested at 11:00 am. LPA observed three (3) fire doors working and in proper condition. Outside: The outside was observed to be clean, free of hazards, and properly furnished with sufficient seating. LPA observed multiple shaded areas for residents. Pool: LPA observed there to be no body of water located within the premises. Administration: The facility had submitted an Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan. The Component III Orientation RCFE was shown/reviewed with the Administrator. The facility was observed to be in compliance with Title 22 Regulations at the time of the visit. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview conducted and copy of this report issued to the administrator.