Pre-licensing visit·October 20, 2025

On October 20, 2025, Licensing Program Analyst (LPA) Manuel Monter, conducted an announced pre-licensing inspection and met with Administrator Mina Abbasvand. This pre-licensing visit is a Change of Ownership, from the previous Facility 435202672 MINAS ELDERLY CARE HOME 1 , to 435202969 MINA'S ELDERLY CARE HOME 1 . The facility is a Residential Care Facility for the Elderly (RCFE). The facility fire clearance is approved for 5 nonambulatory & 1 bedridden. At the time of inspection there are 6 clients observed. LPA and ADM toured the facility inside and outside, which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. The front yard and backyard were inspected. There was no obstruction to block the walkways. LPA toured in the facility garage, which is being used as a storage space. LPA toured the 2nd floor of the facility, which contains 2 staff bedrooms & 1 bathroom. ADM stated the second floor of the facility is for staff use only. The facility has 4 designated exit routes per LIC 610D (emergency and disaster plan). The exits are free from obstruction. The facility has carbon monoxide and smoke alarm detectors that are strategically placed throughout the building. The facility fire extinguishers are placed strategically in the kitchen. The fire extinguishers were serviced on April 17, 2025. Page 1 Out of 2. The laundry area is located in the adjacent to bedroom 6 and the kitchen. The laundry detergents, cleaning supplies and other toxic are locked and can only be accessed by staff. Facility bulletin board contain all necessary documents. LPA observed 7 days of perishable and non perishable food supplies. 6 Out of 6 resident bedrooms have adequate lighting, bed frames with mattress, linens, lamps, night stands, drawer dresser storage and closet space that is sufficient to store clients’ personal belongings. 3 Out of 3 bathrooms hot water temperature measured at 112 degrees Fahrenheit. Room temperature is at 71 degree F. The facility has a centralized air-conditioning system. Medication closest observed to be locked. First Aid kit was observed, which contained first aid supplies, with manual, tweezers and scissor. Facility kitchen equipment is functioning properly, LPA observed locked closet for sharps. LPA reviewed emergency disaster plan and confirmed its completeness. LPA observed cleaning products and chemicals locked an inaccessible to residents in care. Facility bulletin board contain all necessary documents. No issues noted during this Pre-Licensing Inspection. LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. Component III orientation was conducted with Administrator Mina Abbasvand. This report was reviewed with Administrator Mina Abbasvand and a copy of the report was provided. END OF REPORT Page 2 Out of 2.