Pre-licensing visit·June 23, 2025

Licensing Program Analyst (LPA) Mariana Agban conducted a Pre-Licensing Inspection with facility Licensee/Administrator Anna Papoyan. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on January 07,2025. A fire clearance was approved on May 1, 2025 for a maximum capacity of four (4) non-ambulatory, one (1) ambulatory and one(1) Bedridden. Hospice waiver has been approved for five (5) hospice residents. A tour of the physical plant was initiated at 10:30 am and the following was observed: The smoke alarms and carbon monoxide detector are battery-operated and functional. The facility has fire extinguisher near by the kitchen area. The purchase date 02/17/25. 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. LPA observed breakfast table in the kitchen additional to the dinning room area. BEDROOMS: The facility has six (6) rooms. There are five (5) bedrooms designated for residents use. All five 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. Room#1 is used as office/workstation for Administrator and staff. Staff and resident files will be kept and maintained in a locked cabinet in the office room . Room#2 is approved for one(1) bedridden resident. Room#3 is shared and Rooms#2,4,5 and 6 are used as private bedrooms. BATHROOMS: The facility has 2.5 bathrooms. One (1) main bathroom in between residents rooms. Room#3 has private bathroom. Half bathroom will be used by the staff. The hot water delivered in the bathroom sink was measured at 107.4 and 109.8 F. (Continue 809C) COMMON AREAS: These included the living room and dining room, which were equipped with furniture, a television, sofa and chair. There is a fireplace with a screen and a glass slide. It is non-operational. No fireplace tools or fixtures present. The dining area has a dining table to accommodate six (6). There were no visible immediate hazards. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. MEDICATION: The medication will be kept in a locked in the kitchen cabinet. Laundry Room: 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. Garage : The garage is used as extra storage. There is another refrigerator in the garage for additional perishable food items. Garage door is locked and inaccessible to residents. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. 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. 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.