Pre-licensing visit·November 19, 2025

At 09:30 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an announced Pre-Licensing visit to the above facility and met with the Administrator Lusine Tadevosyan, and the Applicant/Licensee, Levon Martirosyan and explained the reason for the visit. At the time of this visit LPA did not observe any residents present in the facility. Fire Clearance dated 10/09/2025 and received for five (5) Non-ambulatory, and one (1) Bedridden (room #3) residents. 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, Division 6. 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 refrigerator, microwave oven, and a sink. Stove was observed in a good working condition. At 09:45 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. LPA observed a Fire Extinguisher and was last purchased on 09/22/2025. It was observed hanging on the wall in the living room. LPA observed that all cleaning supplies to be locked in the laundry area next to the kitchen. The washer/dryer appear to be in good working condition. MEDICATION ROOM: The centrally stored medication will be kept in the locked cabinet in the kitchen. Residents and staff files will be kept locked in the the facility's office which in the main entrance of the facility. BEDROOMS: There are total of four (4) bedrooms. The facility will not have a live-in staff. Four (4) bedrooms are designated for resident’s use. Bedrooms number one (1) and three (3) are shared. Room # two (2) and four (4) are private. Continue on LIC 809C All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. BATHROOMS: There are three (3) bathrooms at the facility. Bathroom number one (1) will be used by staff and visitors only. Two (2) out of three (3) bathrooms will be used by residents only. L PA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 92.8°.The Administrator is going to keep a log for five days of water temperature between 105°F to 120°F. COMMON AREAS: The facility maintains a comfortable temperature at 68°F. The living room and dining area appeared clean and were properly furnished and has a television. No obstructions and or tripping hazards throughout the facility. LPA observed a working telephone for the facility. SURROUNDING GROUNDS: The facility has sufficient backyard space. LPA did observe appropriate outdoor furniture in the backyard of the facility that can accommodate six (6) residents, LPA observe a covered shaded area for residents . There is no swimming pool or any bodies of water at the facility. The exit was free of any obstruction or hazard. Garage/Storage: LPA observed a garage which will be used as a storage for extra supplies. LPA also observed an extra storage which will be used to keep the extra beds and wheelchairs. Both the garage and storage areas will be kept locked and inaccessible to residents in care. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:05 AM, they were tested and observed to be operational. Component III was conducted with the Licensee/Administrator. Continue on LIC 809C The licensee will need to complete the following: 1. Hot water temperature log for five (5) days. Please submit the above item within five (5) days. The facility is ready for operation upon completion of requested item in this report and final approval of the application. The licensee/Administrator should notify the Licensing agency of the admission of their first resident. Exit interview was conducted and with a copy of this report was provided to the Applicant/Administrator.