Pre-licensing visit·February 7, 2025

On 2/7/25 at 10:00am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted a Pre-Licensing Inspection with the facility Rima Agaronyan. This is a Change of Ownership Application from facility #197610314 to #197610703 to operate an Residential Care Facility for Elderly (RCFE). A Change in Ownership (CHOW) Application to operate the RCFE was received by Community Care Licensing (CCL) on September 20th, 2024. A fire clearance was approved on October 16th, 2024, for five (5) Non-Ambulatory residents and one (1) Bedridden resident for bedroom #1. The smoke alarms and carbon monoxide detectors are hard wired and inter-connected, they were tested and are operational. The facility has one (1) fire extinguisher that was purchased on 9/7/2024 and is located on the wall next to the dining room. A tour of the physical plant was initiated at approximately 10:45am and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, gas stove, microwave oven and sink. There were adequate supplies of two (2) days of perishable and seven (7) days of nonperishable food, dining ware to accommodate a maximum capacity of six (6) clients. Knives and other sharps were observed locked inside kitchen cabinet next to the sink and chemicals observed stored inside locked cabinet under the sink. BEDROOMS: The facility has five (5) bedrooms and all bedrooms are designated for residents' use. All residents' bedrooms observed to be nicely furnished with beds, night stands, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. Additional linen is available inside each bedroom’s closets. BATHROOMS: The facility has three (3) bathrooms, of which two (2) are designated for residents’ use and one (1) for staff use. All bathrooms were observed to have the proper fixtures, grab bars, non-skid mats, trash cans with closed lids. The hot water delivered in the bathrooms measured at 11:00am to be at 109.8 degrees. Continue On LIC809-C COMMON AREAS: These included living room and a dining room. The living room was equipped with furniture, a television, tables and chairs. There is no fireplace in the facility. The dining area has a dining room table to accommodate six (6) clients. There were no visible immediate hazards. The facility has comfortable temperature which was measured at 11:15am to be 73 degrees. GARAGE: The garage is used as extra storage for non-perishable, emergency food supplies and water. There is another freezer/refrigerator in the garage for additional food items. LAUNDRY ROOM: The washer and dryer is located in a separate are next to the kitchen. Laundry chemicals are also kept in the laundry area which is always locked and under supervision. MEDICATIONS: Medications are kept locked inside commercial cabinet located in the office area which is next to the living room. At approximately 12:00pm to 1:00pm LPA observed each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. All medications are properly labeled and checked for expiration dates. First Aid and the new manual is also locked in the cabinet. LPA observed the First-aid has all proper items and is current. Client Files : From 11am to 12pm LPA conducted a file review of all client records to ensure compliance of licensing forms. Clients’ files are complete and kept locked in the in the cabinet located in the office. Staff Files : Staff files are also kept in a locked cabinet located in the office. From 12:00pm to 12:30pm LPA conducted staff file review, files were complete with all documents and training certificates. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home were clear of obstruction. The backyard of the facility is properly fenced, has a patio and backyard furniture to accommodate six (6) clients. There is a pool in the backyard which was observed to be properly fenced and locked. Continue on LIC809-C In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised. An emergency exit plan/sketch is posted on the hallway wall along with other posting requirements. No deficiency cited on today’s visit. LPA collected LIC500, LIC9020, Exit interview conducted and copy of this report signed and delivered to the Administrator.