Pre-licensing visit·April 3, 2025

Licensing Program Analyst (LPA) Gary Tan conducted a Pre-Licensing Inspection with the applicant representative Nazeli Khechoyan. The applicant is "MIaMon Assistant Living". A fire clearance was approved on 11/14/24 for six (6) non-ambulatory residents, one (1) of which may be bedridden on Room #2. The facility has a total of four (4) bedrooms and two (2) bathrooms. A tour of the physical plant was initiated at approximately 9:26 AM and the following was observed: KITCHEN: The facility has a Kitchen that is equipped with a refrigerator, microwave, stove, dishwasher and sink. There was an adequate supply of perishable and nonperishable food. Knives were observed locked in a kitchen drawer. Cleaning supplies and other toxins will be stored in the cabinet in the garage which was locked during visit. BEDROOMS: There are four (4) bedrooms designated for client's use; two (2) private and two (2) shared. The applicant furnished the resident bedrooms with beds, night stand, chairs, dressers, bedding and linen. The bedrooms have sufficient lighting and storage. BATHROOMS: The facility has two (2) shared bathrooms for clients' use. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured at a range of 117.9°F to 118.4°F. LAUNDRY ROOM: The laundry area is located in the garage. Laundry detergents and other cleaning agents were locked in a cabinet inside the garage. The garage was observed to be locked during visit. (continued on LIC 809-C) (continued from LIC 809) COMMON AREAS: These included the living room and the dining area. Living room was furnished with chairs and side tables. The living room area was furnished with a television, a coffee table and sofa to sit the capacity of the facility. There were no visible immediate hazards. Cleaning supplies and chemicals are stored and locked in a cabinet in the garage. There is a working telephone line and internet accessible to residents. Dual smoke/carbon monoxide alarms were tested and observed to be operational. Fire extinguisher was last bought on 03/22/25. MEDICATIONS: The medication cabinet is located in the kitchen and has a locking mechanism. A complete first aid kit is located inside the medication cabinet. Staff/Resident Records: Staff and resident records will be kept in a filing cabinet. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a covered patio and backyard furniture to accommodate the residents. The Garage is attached to the house, locked and inaccessible to residents and currently being used as laundry area and storage. There is no body of water in the facility. Component III was conducted with the Administrator and Licensee Representative. No deficiencies were observed during visit. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. Copy of this report issued.