Pre-licensing visit·May 8, 2026

On 5/8/2026 at 11:50am Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an announced Pre-Licensing Inspection at the facility. Upon arrival LPA met with the Administrator Vigen Melkonyan, introduced herself showing the department badge and conducted an entrance interview. Fire Clearance was approved on 1/27/2026 for a maximum capacity of six (6) residents, of which five (5) can be non-ambulatory. This is a single-story house with four (4) bedrooms and three (3) bathrooms. All bedrooms are designated for residents’ use only. Facility will have an awake night shift staff on premises. At 12:10pm a physical plant was toured inside and out of the property with the assistance of the Administrator and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a new refrigerator, microwave oven and sink. At 12:20AM, 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, which was purchased on 5/8/2026. Laundry Area: A functioning washer and dryer are located in the garage. Disinfectants, laundry detergents, and hygiene supplies were stored securely inside a locked cabinet and were inaccessible to clients. Continue on LIC809-C COMMON AREAS: At 12:35pm LPA observed the living/family room and dining room furniture to be clean and in good repair. The facility maintains a comfortable temperature at 72°F. The air conditioner is operational. No firearms observed or will be maintained on the premises. Licensee has ordered puzzles, books, balls, and board games to provide activities to clients in care. No obstructions and or tripping hazards observed throughout the facility. Bedrooms: There are four (4) bedrooms in the facility designated for residents’ use only. Bedrooms are furnished and well equipped with beds, nightstands, chairs, dresser, bedding, pillowcase, mattress pad, and blankets; extra linen is available inside the linen closet located in the hallway. Rooms were observed to have sufficient lighting and closet space. LPA observed appropriate window screens. Sufficient supplies of personal hygiene products stored in the storage area and will be provided to the clients by the Licensee. Facility will have an awake staff. BATHROOMS: The facility has three (3) bathrooms, all bathrooms are designated for residents’ use. Bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 12:55pm to be 112.6F degrees. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 1:10am they were tested and observed to be operational. Facility has phone which was checked at 1:00pm to be operational. Medications: LPA observed medications will be kept centrally stored and locked inside the commercial cabinet next to the dining table. The key cannot be accessible to residents in care. Clients and staff files will also be kept inside the commercial cabinet. SURROUNDING GROUNDS: The facility has sufficient yard space. LPA observed the backyard with appropriate outdoor furniture and covered shaded areas for clients. LPA discussed the importance of maintaining care and supervision to meet the needs of clients. GARAGE: There is a garage on the property that is currently being used for storage and contains installed laundry machines. The garage is accessible from the kitchen area, and the door will remain locked at all times. Continue on LIC809-C Component III was conducted with the Licensee/Administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and will be notified by the CAB Analyst when the license has been approved. LPA collected copy of the Administrator Certificate – Exp date: 8/27/2026 LPA also informed Administrator to update the new form of the Emergency Disaster Plan and submit it to the department. Exit interview was conducted, a copy of this report signed and delivered to the Administrator.