Pre-licensing visit·September 12, 2025

Licensing Program Analyst (LPA) Jose Tan conducted an announced Pre-Licensing Inspection with the applicant representative and Administrator ZHIRAYR AYVAZYAN. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 02/20/25. A fire clearance was approved on 03/18/25 for six (6) non-ambulatory residents, one (1) of which maybe bedridden on Room #3. The applicant will also be requesting a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detector are dual and inter-connected. The facility has a brand-new fire extinguisher located in the kitchen and last purchased on 08/23/25. Facility is a single storey home. Today's site visit consisted of LPA touring the physical plant at 9:23 AM inside and outside and observed the following: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and sink. There was an adequate supply of non-perishable food items observed. Perishable food items not required at this time as there are no residents. Administrator was advised facility needs to carry perishable food items once they admit residents for care. Knives were observed locked in a kitchen cabinet. Cleaning supplies observed locked in the cabinet beside the washer and dryer. BEDROOMS: There are three (3) bedrooms designated for client use, all shared. The bedrooms were observed to have appropriate furniture and sufficient lighting. Auditory alarms were tested and observed to be operational. Facility appears to be clean and in good repair. Appliances in the kitchen appeared to be functional. The facility has a working telephone and internet on the premises. (continued on LIC 809-C) (continued from LIC 809) BATHROOMS: The facility has three (3) bathrooms. One (1) is designated for staff use only. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at a range of 113.4°F to 116.8°F COMMON AREAS: These included the living room and dining room areas. The living room has a couch, chair, table, and television. There is a shaded area with furniture in the backyard for residents' use. The dining room has a table large enough to seat six (6) residents. LAUNDRY ROOM: The laundry area is located adjacent to the kitchen. Laundry detergent, cleaning agents and other toxins are kept locked in the laundry cabinet. GARAGE is attached to the house but has no access from the inside, it is also being used as emergency food, PPE, tools and other miscellaneous storage. MEDICATIONS: Medications will be kept locked in a cabinet in the kitchen. Complete First aid kit is located in the kitchen. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional. The swimming pool is appropriately fenced and observed to be locked during visit. There is a sitting area in the front yard for residents to conduct outdoor activities. The backyard is fenced and has proper locking mechanism. Component III was waived as approved by LPM Troy Agard as the licensee has another existing facility. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready to be licensed. CAB will be advised and a copy of this report provided Exit interview conducted. Copy of this report issued.