Pre-licensing visit·July 25, 2025

Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant/administrator, Maya Sargysyan. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on May 19, 2025. This a change in location application. The census where the current license is active at this time is five (5). All five of those residents will be moving to this location once applicant's license gets approved. Their furniture will also be relocated to this address. This facility is a one story building. A fire clearance was approved on June 4, 2025 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six (6). The smoke alarms and carbon monoxide detector are dual, hard wired and inter-connected. The facility has one new fire extinguisher located by the kitchen. It was purchased on May 5, 2025. A tour of the physical plant was initiated at approximately 9:15am and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven and sink. Knives will be kept locked in a kitchen drawer. Cleaning supplies will be kept locked underneath the kitchen sink. Medications will be kept locked in a kitchen cabinet. . BEDROOMS: There are five (5) Rooms. Four (4) bedrooms are designated for resident use. One (1) room will be utilized as staff office. Bedrooms #3 and #4 is private. Bedrooms #2 and #5 are shared. Per STD 850, rooms #2 or #5 are clear for bedridden. Room #1 is for staff only. Bedrooms designated for resident use have sufficient lighting and closet space. BATHROOMS: The facility has two and a half (2 1/2) bathrooms. The two bathrooms, designated for resident use were observed to have proper fixtures, grab bars, and non-skid mats. The hot water temperature measured between 105-108 degrees. The half bathroom is for staff use only. Common Areas: LPA toured all common areas to insure everything is in good repair. Both living room and dining room have sufficient space and lighting. Floors were clean and maintained. Entrance/exits are clear of obstruction. Applicant stated, all furniture, from current address where license is active, will be transferred over to this location once license is approved. Staff Office/Workstation: Room #1 is designated for staff use. Administrator will utilize this room as her office to maintain staff and resident records. Outside areas: LPAs toured the outside area of the facility to insure the front and back yards of the facility is clear of obstruction. There is sufficient yard space to keep outdoor furniture and hold outdoor activities at the backyard. Passageway/exits to both side gates are free of any hazards. There is no swimming pool or any other bodies of water. Garage: The garage is attached to the building. Entrance is through the main front. There is also a backdoor to the garage, located at the backyard. Both doors to garage will be kept locked at all times. Laundry: Laundry area is located in the garage. No Component III held at this time as this is a Change in Location application. Pursuant to CA code of Regulations Title 22 and Health and Safety Code, the facility physical plant is compliant. Exit interview conducted and a copy of this report provided.