Pre-licensing visit·September 23, 2025

Licensing Program Analyst (LPA) Nadia Shahbazian conducted a Pre-Licensing Inspection and met with the Administrator Tatevik Khachikyan . An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on September 4, 2025. A fire clearance was approved on August 8, 2025 for six (6) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six. In addition, facility has an approved hospice waiver to retain six (6) hospice residents. Facility is a one story rental home, located on a busy street. The building consists of four (4) bedrooms, two (2) bathrooms, dining room and living room and a detached garage, currently used as storage. With the assistance of the administrator, a tour of the physical plant was initiated and the following was observed: The required posting were posted in the hallway, accessible to residents. The smoke and carbon monoxide detectors are dual and inter-connected. At 11:05am, smoke/carbon monoxide detectors were tested and observed to be functional. Facility is equipped with a fire door in the living room, leading to the hallway. During the smoke/carbon monoxide testing, LPA observed the fire door closing properly. The facility has a brand new fire extinguisher purchased on 08/01/25. Fire extinguisher is located at the living room. KITCHEN: The kitchen is equipped with brand new appliances, including a refrigerator, stove/oven, microwave oven, dishwasher and coffee maker. There was an adequate supply of non-perishable food items and supply of dishes in kitchen cabinets. Perishable food items are not required at this time, as there are no residents. Administrator was advised that facility needs to carry perishable food items once they admit residents for care. Knives were observed locked in a kitchen drawer. Cleaning supplies were observed locked underneath the kitchen sink, in addition there is a tanked water filter underneath the kitchen sink. Continued on 809-C BEDROOMS: There are four (4) bedrooms designated for client use. All the bedrooms were furnished with b eds, night stands, chairs, closets and supply of bedding and linens. The bedroom # 3 is designated as bedridden room and it has it's own exit door. Bedroom # 4 has it's own bathroom and an exit door, leading to the backyard. BATHROOMS: The facility has two (2) bathrooms. Bedroom #4 has it's own bathroom with shower. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 118.1 and 118.4 degrees Fahrenheit. The laundry area is located in the bathroom next to bedroom # 1. LPA observed the dryer to be stacked on top of the washer; both machines are brand new. The laundry chemicals and detergents were observed in a locked cabinet in the bathroom. COMMON AREAS: The open concept common area includes a living room and dining room. The living room has an L-shape couch, table, and television. There is a cabinet in the living room, containing games and art/craft items. The dining room is located near the kitchen and has a table large enough to seat six (6) residents. MEDICATIONS: Medications will be kept locked in a kitchen cabinet. There is a complete first aid kit and first aid manual in the medication cabinet. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alerts, when the doors open. The backyard of the facility is large enough to hold outdoor activities. LPA observed patio furniture, set inside a covered gazebo. There is no swimming pool or body of water. There are two side exit gates in the backyard, to be used in emergency cases. The garage was converted to a room, with it's own full bath and a kitchenette with refrigerator. The garage is listed as "storage" on the sketch and it will be used as office space and possibly staff break room. In addition to the Pre-Licensing inspection, a Component III power point presentation was held. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.