Pre-licensing visit·June 2, 2025

At 9:30 AM, Licensing Program Analyst (LPA), Huma Rahimi conducted an announced Pre-Licensing visit to the above facility and met with Gurgen Keveyan, Licensee, and explained the reason for the visit. At the time of this visit LPA did not observe any residents present in the facility. Fire Clearance dated 04/22/2025 and received for six (6) Non-ambulatory residents of which two (2) are Bedridden in bedroom #4. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. 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 refrigerator, oven, and a sink. Stove was observed in a good working condition. At 9:40 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. LPA observed a Fire Extinguisher and was last purchased on 04/09/2025. It was observed handing on the wall in the dinning area. MEDICATION ROOM: The centrally stored medication will be kept in the in the locked cabinet in the office area of the facility. Facility staff and residents files will be kept locked in a separate cabinet in the office area. BEDROOMS: There are five (5) bedrooms designated for residents use. One (1) bedroom is shared and four (4) bedrooms are private. LPA observed that all bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. The facility will have an awake staff Continue on LIC 809C BATHROOMS: There are five (5) bathrooms at the facility. One of the bathroom is located in the office and for staff use only. L PA observed all bathrooms are clean and in a good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 111.4°. LAUNDRY ROOM: The laundry room is located in the in the office area and all cleaning supplies and laundry detergents will be kept locked in one of the bathrooms cabinet and inaccessible to residents in care. The washer/dryer appear to be in good working condition. COMMON AREAS: The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean and were properly furnished and has a television. No obstructions and or tripping hazards throughout the facility. LPA observed a working telephone for the facility. SURROUNDING GROUNDS: The facility has sufficient backyard space. LPA did observe appropriate outdoor furniture in the backyard of the facility that can accommodate six (6) residents, There is no swimming pool or any bodies of water at the facility. The exit was free of any obstruction or hazard. Garage/Storage: The facility does not have an extra space or a garage. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 9:45 AM, they were tested and observed to be operational. Component III was conducted with the Licensee/Administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved. Exit interview was conducted and with a copy of this report was provided to the Applicant/Licensee