Pre-licensing visit·March 26, 2026

On 3/26/2026 at 10:00am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted a Pre-Licensing Inspection with the Administrator Ghukasyan Kristine. This is a Change of Ownership Application from facility #197610320 to #197610911 to operate an Residential Care Facility for Elderly (RCFE). A Change in Ownership (CHOW) Application to operate the RCFE was received by Community Care Licensing (CCL) on 9/19/2025. A fire clearance was approved on December 30 th , 2025, for five (5) non-ambulatory residents, and one (1) Bedridden resident for bedroom # 3. Facility has Hospice waivers granted for six (6) residents. The smoke alarms and carbon monoxide detectors are hard wired and inter-connected; they were tested and are operational. The facility has two (2) fire extinguishers that were serviced on 3/14/2026 and will be located on the kitchen wall and in the hallway. A tour of the physical plant was initiated at approximately 10:45am and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, gas stove, microwave oven and sink. There were adequate supplies of two (2) days of perishable and seven (7) days of nonperishable food, dining ware to accommodate a maximum capacity of six (6) residents. Knives and other sharps were observed locked inside the kitchen cabinets and chemicals observed stored inside locked cabinet under the sink. COMMON AREAS: These include living room and a dining room. LPA observed the area was generally clean and organized. The living room was equipped with furniture, a television, tables and chairs. There is fireplace in the living room which is blocked and not accessible to residents. The dining area has a dining table to accommodate six (6) residents. There were no visible immediate hazards. The facility has comfortable temperature which was measured at 10:55am to be 70 degrees F. Continue on LIC809-C BEDROOMS: The facility has four (4) bedrooms, and all bedrooms are designated for residents' use. All residents' bedrooms were observed to be nicely furnished with beds, nightstands, lamps, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. Additional fresh linen is available inside the linen cabinet located in the hallway. Bedrooms #1 and #2 are for non-ambulatory residents and bedrooms #3 is for bedridden only. BATHROOMS: The facility has two (2) bathrooms, both designated for residents’ and staff use. All bathrooms were observed to have the proper fixtures, grab bars, non-skid mats, trash cans with closed lids, paper towels/ hand dryer and washing hands signs. The hot water delivered in the bathrooms measured at 11:10am to be at 110.1 degrees. Bathroom #1 is located in the hallway next to bedroom #2 and bathroom #2 is inside bedroom #3. GARAGE: LPA observed that there is a garage located on the premises and was informed by the licensee that they recently received approval to convert the structure into an Accessory Dwelling Unit (ADU). The licensee stated that the required documentation and notification related to this approval will be submitted to the department for review. LAUNDRY ROOM: The washer and dryer is located in the hallway, inside a separate laundry area. Laundry chemicals are always locked and under supervision inside a separate cabinet. Client Files : From 11:05am to 12:00pm LPA conducted a file review of all client records to ensure compliance of licensing forms. Clients’ files are complete and kept locked inside the kitchen cabinet. Staff Files : Staff files are also kept inside a locked kitchen cabinet. From 12:00pm to 12:20pm LPA conducted staff file review, files were complete with all documents and training certificates. MEDICATIONS: Medications are kept locked inside the kitchen cabinet. At approximately 12:15pm to 12:45pm LPA observed each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. All medications are properly labeled and checked for expiration dates. First Aid and the new manual available and locked inside the kitchen cabinet along with medications. LPA observed the First-aid has all proper items and is current. Continue on LIC809-C SURROUNDING GROUNDS: The driveway, passageways and entrance to the home were clear of obstruction. The backyard of the facility is properly fenced, has a patio and backyard furniture to accommodate six (6) residents. There is no pool or body of water in the premises. There are two (2) exit gates on both sides of the property, LPA checked gates were unlocked and easily accessible. LPA observed the facility is clean, safe, sanitary and odorless. All window screens were in good repair. Auditory signals were installed on exit doors and operational. All passageways were free of obstruction. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised. An emergency exit plan/sketch along with other posting requirements were available in the hallway next to the entrance. No deficiency cited on today’s visit. Exit interview conducted and copy of this report signed and delivered to the Licensee/Administrator.