Pre-licensing visit·October 22, 2025

Licensing Program Analyst (LPA) Evelin Rios conducted a Pre-Licensing inspection with both the applicant representative and administrator, Arlen Shahverdian and Ariga Mirzakhanian. An application to operate a Residential Care Facility for the Elderly was received by Community Care Licensing (CCL) on July 8, 2025. The fire clearance was approved on 07/17/2025 for six (6) non-ambulatory residents for a total capacity of six (06). A tour of the physical plant was initiated at approximately 9:45am and the following was observed: COMMON AREAS: These include the living room and dining room. The living room is furnished with sufficient seating, couches, and table. There is a fireplace that is secured with a screen. No fireplace tools present. The dining room table can accommodate the capacity. Common areas were observed free from any hazards. BEDROOMS: There are four (4) bedrooms designated for resident use. Bedroom #1 and #2 are shared rooms. Bedroom #3 and #4 are private. The resident bedrooms are furnished with beds, night stand, chairs, chest of drawers, bedding and linen. The bedrooms have sufficient lighting and closet space. Passageways and exits from each bedroom are free and clear of any obstruction. The smoke alarms and carbon monoxide detector are dual, hard wired and inter-connected. The facility has one fire extinguisher, located at the kitchen/dining room area. The fire extinguisher was purchased on June 11, 2025. (Continue to LIC809) BATHROOMS: The facility has two (2) bathrooms. Bedroom #1 has it's own private bathroom with shower. The second bathroom, is located in the hallway by the other resident bedrooms. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid flooring. The hot water temperature was test in the hallway bathroom and measured 113.4 degrees Fahrenheit. KITCHEN: The kitchen area is equipped with a refrigerator, stove/oven, dishwasher, microwave and sink. At this time, perishable food items are not required as there are zero (0) residents. There is an adequate supply of nonperishable and emergency food stored in the garage. There is also sufficient dining ware to accommodate the capacity of the facility. Knives and sharps were observed locked in a kitchen drawer. LAUNDRY ROOM / GARAGE: The laundry room is equipped with a washer and dryer. The laundry room is able to lock making inaccessible to residents. Detergents, and cleaning supplies will be stored locked in a cabinet above the washer and dryer. There is an attached garage, accessible through the laundry room. OUTSIDE: The backyard is entirely fenced in. There is a detached garage and shed used for storage. No bodies of water observed. There is sufficient space for outdoor activities. MEDICATIONS / RECORDS: Medications and records will be stored in a closet the kitchen and laundry room. Closet will be able to lock. First aid kit and manual will be maintained in the medication closet. Component III was conducted with the Licensee representative and the Administrator. Pre-Licensing is complete, and this facility has no deficiencies. This report will be sent to Centralized Application Bureau (CAB). You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. Copy of this report provided.