Pre-licensing visit·December 4, 2025

On 12/4/2025 at 12:00PM Licensing Program Analyst (LPA), Perchui Milena Khurshudyan conducted an announced Pre-Licensing visit to the above facility and met with facility Licensee/Administrator Korshiya Kristina. Fire Clearance was approved on 10/6/2025 for a maximum capacity of six (6) residents, of which five (5) can be Non-ambulatory and one (1) Bedridden resident for bedroom #1. Facility has a Dementia Care Program. 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. 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 new refrigerator, microwave oven and sink. At 12:50PM, LPA observed adequate supplies of nonperishable food properly stored in the cabinets and inside the supply room. Perishable food items are not required at this time as there are no residents in the facility. LPA observed dining ware to accommodate a maximum capacity of six (6) residents. All knives and sharps are observed to be locked inside a kitchen cabinet and inaccessible to residents in care. The facility has one (1) new fire extinguisher, appeared to be full and serviced and were last purchased on 8/13/2025. BEDROOMS: There are four (4) bedrooms in the facility, and all are designated for residents’ use, there is no staff room on the property. All bedrooms are furnished with beds, dressers, chairs, nightstands and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational at 1:30PM. Facility will have awake staff at night. Emergency call buttons will be provided to residents if necessary. Continue on LIC809C LAUNDRY ROOM: The laundry room is located in a separate closet next to the kitchen. The washer/dryer appears to be new and in good condition. Laundry supplies along with other chemical items will be kept locked inside the cabinets and under supervision when not in use. BATHROOMS: Facility has two (2) bathrooms. At 1:45PM LPA observed all bathrooms are clean, in good repair and properly supplied with toilet paper, soap and paper towels. LPA observed appropriate grab bars and non-skid mats in all bathrooms. Trash cans had closed tight fitting lids throughout the facility. Water temperature was within regulation, and it was measured by an LPA at 1:55PM to be 118F degrees. All bathrooms are designated for Staff and residents use. COMMON AREAS: The facility maintains a comfortable temperature at 68°F. The living room and dining area appeared clean and were properly furnished. The facility has activity puzzles, coloring books, crayons, board games and other activity supplies available for residents. No obstructions or tripping hazards throughout the facility. An emergency exit plan/sketch is posted along the hallway with other posting requirements. Facility has décor fireplace in the living room which is non-operational. No firearms observed or will be maintained on the premises. MEDICATION ROOM: The medication and facility staff/resident files will be centrally stored inside the locket commercial cabinet located in the staff office area First-aid kit was checked to be complete and has the new manual available. The facility will have at least one (1) staff member for each shift (AM and PM). SMOKE DETECTORS/CARBON MONOXIDE. Dual smoke detectors and carbon monoxide throughout the facility. At 1:10 PM they were tested and observed to be operational. Continue on LIC809-C SURROUNDING GROUNDS: The facility has open entrance and sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The backyard is fenced. There is no garage on the property. LPA discussed the importance of maintaining care and supervision to meet the needs of the residents. The facility has land line, checked by an LPA to be operational. Component III was conducted with the Administrator. Based on inspection and observation, the physical plant is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and the applicant will be notified by the CAB Analyst when the license has been approved. Exit interview was conducted and a copy of this report was provided to the Applicant/Administrator.