Pre-licensing visit·February 23, 2026

On 2/23/2026, at approximately 09:45 AM, Licensing Program Analyst (LPA) Angelica Segovia and Policy Manager (Supervisor I) Carly Hansford conducted an announced Pre-licensing visit. LPA Segovia met with Administrator Ariga Mirzakhanian and Licensee, Arlen Shahverdian. An application was submitted to Community Care Licensing Division-CCLD on 11/18/2025, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The requested capacity is for twenty (20) non-ambulatory residents of which two (2) may be bedridden. The fire clearance was approved on 1/27/2026. A physical plant tour was conducted and the following was noted: Structure: The facility is a two-story building with ten (10) bedrooms and five (5) bathrooms. One (1) room, located on the second floor, is a designated staff room with its own bathroom. Entrance: There is one (1) main entrance/exit being utilized. Required postings such as: See/Say Something and Long-Term care Ombudsman were observed immediately upon entrance. Common Areas: These include both living room and dining room. All common areas were observed to be neat, clean and organized. All common areas were properly furnished and in good repair. The facility maintains a comfortable temperature of seventy-one (71) degrees. No firearms observed or will be maintained on the premises. Residents/staff files: The resident and staff files will be kept in locked staff room inaccessible to residents. LIC809C-continued Kitchen: Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods will be purchased prior to residents’ arrival. LPA observed sufficient supplies of dishes, cups and silverware readily available for the residents upon arrival. Working stove and refrigerator observed and in proper condition. The Sharps/Knives will be stored in a locked kitchen drawer. The toxins/Cleaning solutions will be kept locked in various kitchen storage cabinets and inaccessible to residents. Medications: The medications will be stored in a locked storage cabinet located near the kitchen. Medication storage is equipped with a lock to ensure medications will not be accessible to residents. First-aid kit observed as well. Emergency: The Fire extinguishers were observed to be located throughout the facility. LPA observed the fire extinguishers to have been inspected, fully charged and dated 1/10/2026. Bedrooms: All ten (10) designated resident bedrooms were observed to be properly furnished with bed, nightstand, applicable lightening and seating. LPA observed auditory alarms within each bedroom to be in proper and working condition. Bathroom: The bathrooms will be maintained in proper condition. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Hallways: Hallway is properly lighted. Extra linens/covers will be stored in storage cabinets. Laundry Room: The laundry room is located within the hallway’s passageway leading towards bedrooms #1 to #7. All cleaning solutions and toxins will be kept stored in locked cabinets inside the laundry room. Dryer and washer observed to be in proper condition. The Garage: LPA observed there to be no garage located within the premises. Staff room: The staff room will be kept locked and inaccessible to residents. Water Temperature: The water temperature was measured within regulations. LIC809C-continued Smoke detectors: Dual interconnected smoke detectors and carbon monoxide observed to be working properly and were tested. Outside: The outside is clean, free of hazards, and properly furnished with sufficient seating. A shaded area for residents was observed as well. LPA observed a locked storage unit. Pool: No body of water located on premises. Administration: The facility has submitted an Emergency and Disaster Plan for Residential Care Facilities for the Elderly. The Component III Orientation Residential Care Facility for the Elderly (RCFE) was waived due to the Administrator’s qualifications. The facility is not yet in compliance with Title 22 Regulations at this time. The Administrator will work on the following and submit corrections to CCLD prior to approval: -Inclusion of Facility’s Program Design and Admission Agreement to reflect the use of video surveillance with no auditory use in the common areas (hallways, exterior of facility and so forth). -Bedroom locks on all ten (10) bedrooms will be fixed or removed to ensure residents’ rights are not infringed upon. -Replacement of all bedroom window coverings/screens. -One (1) of the five (5) restrooms located between room #8 and #9 will need to have completion of the shower and bathroom sink installed and in proper working condition. Once completed, this report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview was conducted and copy of this report issued to the licensee.