Pre-licensing visit·July 3, 2025

On 7/3/2025 at 9:30AM Licensing Program Analyst (LPA), Perchui Milena Khurshudyan conducted an announced Pre-Licensing visit to the above facility and met with facility Administrator Anna Gasparyan. LPA introduced herself by showing her department badge and conducted entrance interview. Fire Clearance was approved on 02/12/2025 for a maximum capacity of six (6) non-ambulatory residents, of which one (1) can be Bedridden resident in bedroom #5. Facility has a Dementia Care Program. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under the California Code of Regulations, Title 22. The facility is a single-story building. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: KITCHEN: The facility has a Kitchen area that is equipped with a new refrigerator, microwave oven and sink. At 9:45AM, LPA observed adequate supplies of nonperishable food properly stored inside the kitchen cabinets. Perishable food items are not required at this time as there are no residents in the facility. Licensee will supply sufficient amount of perishable food upon arrival of the residents. LPA observed dining ware to accommodate a maximum capacity of six (6) residents. All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents in care. The facility has one (1) new fire extinguisher, which was purchased on 02/04/2025. BEDROOMS: There are five (5) bedrooms designated for residents’ use. All bedrooms are furnished with beds, dressers, chairs, nightstands and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational at 10:20AM. There is no bedroom designated for staff use. Facility will have awake staff at night. Continue On LIC809-C LAUNDRY ROOM: The laundry area is next to the kitchen. The washer and dryer machines appear to be new and in good condition. Laundry supplies along with other chemical items observed locked and under supervision when not in use. BATHROOMS: Facility has three (3) bathrooms. At 10:35am LPA observed all bathrooms are clean, in good repair and properly supplied with toilet paper, soap and paper towels. LPA observed appropriate grab bars and non-skid mats in all bathrooms. Trash cans had closed tight fitting lids. Water temperature was within regulation, and it was measured by an LPA at 10:50am to be at 106.3°F degrees. COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The living room and dining area appeared clean and were properly furnished. Activity supplies were nicely organized inside the office area. Activities include puzzles, coloring books, crayons, and board games. No obstructions or tripping hazards throughout the facility. An emergency exit plan/sketch is posted along the hallway with other posting requirements. The facility has a fireplace which is properly fenced. LPA informed the fireplace is not operational. No firearms observed or will be maintained on the premises. MEDICATION: The medication will be kept inside the commercial cabinet which is placed between the dining and kitchen area. The facility staff/resident files will be kept centrally stored and locked in the office area between the living room and the kitchen. First-aid kit was checked to be complete and has the new manual available. The facility will operate with two (2) shifts (AM and PM). SMOKE DETECTORS/CARBON MONOXIDE. Dual smoke detectors and carbon monoxide were located in the bedrooms and throughout the facility. At 10:55am they were tested and observed to be operational. SURROUNDING GROUNDS: The facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The backyard is fenced. LPA discussed the importance of maintaining care and supervision to meet the needs of the residents. There is a pool in the backyard, properly fenced and locked. The facility has land line, LPA checked to be operational. LPA observed the facility is clean, safe and sanitary. All window screens were in good repair. Auditory signals were installed on all exit doors. All passageways were free of obstruction. Continue on LIC809-C GARAGE: The garage is currently being used as storage for facility equipment, supplies and water. The garage is attached to the facility; however, it has no access from the house. Component III: On 7/3/2025 during Pre-Licensing visit at the facility, the Administrator Anna Gasparyan completed Component III. At which time it was explained how to operate the facility within substantial compliance, The Administrator also had an opportunity to ask questions. Based on inspection and observation, the physical plant is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and the applicant will be notified by the CAB Analyst when the license has been approved. Exit interview conducted and copy of this report signed and delivered to the Administrator.