Pre-licensing visit·April 21, 2025

Licensing Program Analyst (LPA) Mariana Agban conducted a Pre-Licensing Inspection with Administrator Victoria Hayrapetyan and Licensee Ani Tigranyan. A Change in Ownership (CHOW) Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on December 3, 2024. A fire clearance was approved on March 19, 2025, for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six. All bedrooms are cleared for one bedridden resident. A dementia plan of operation has been submitted. A hospice waiver has been requested for six (6) residents pending the Manager's approval. The smoke alarms and carbon monoxide detector are battery-operated and functional. The fire extinguisher is located in the kitchen with a purchase date of 04/15/25. A tour of the physical plant was initiated at approximately 9:45 am and the following was observed: KITCHEN : The facility has a Kitchen area equipped with a refrigerator, microwave oven, and sink. Adequate supplies of perishable and nonperishable food and dining ware accommodated a maximum capacity of six (6). Medications are kept locked in storage cabinet next to the fire extinguisher in the kitchen. BEDROOMS : There are five (5) bedrooms designated for residents' use. Bedrooms #2, #3,#4, and #5 are designated for private use. Bedroom#1 is a shared bedroom. The rooms are furnished with beds, nightstands, chairs, dressers, bedding, and linen. The bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has two (2) bathrooms for the residents' use. One is located in the main hallway and one private in Room #2. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. Water temperature in the bathrooms measured between 105-109 degrees F . No cleaning supplies or hazardous items were present in each bathroom. (Continue on 809C) COMMON AREAS : These included the living room and dining room. The living room was equipped with furniture, a television, tables, and chairs. The dining area has a dining room table to accommodate six (6). LPA observed a large pantry that is used as extra storage for non-perishable and emergency food supplies and water. There were no visible immediate hazards. There is a functioning telephone on the premises in the living room. GARAGE/Laundry : The garage is attached to the building. Entry to the garage from outside the home. LPA observed the sliding glass door locked. The garage is used as storage. LPA observed storage boxes and cleaning supplies. Laundry detergents are kept locked in the garage and inaccessible to residents. The washer and dryer are located in the garage. LPA observed that the washer and dryer are in good repair. There is another refrigerator in the garage for additional perishable food items. Residents/Staff Records: Residents and staff records were reviewed to ensure compliance. SURROUNDING GROUNDS : The driveway, passageways, and entrance to the home were clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility's backyard has sufficient yard space. 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.