Emily's Villa

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Erica Mosley conducted a Pre-licensing visit at 10:00 a.m. and met with the Applicant Angela Khacheryan. This is a new facility. The application is for a Residential Care Facility for the Elderly (RCFE), for five (5) non-ambulatory residents and one (1) ambulatory resident. The pending facility has a Dementia Care Program. Fire Clearance was approved on 03/19/2026. Age range sixty (60) and over. Approved for six (6) residents of which one (1) may be ambulatory and five (5) may be non-ambulatory. Ambulatory in room #1 only, Non-ambulatory in rooms #2,3,4 only. Garage is to be used as garage only no sleeping. Hospice waiver granted for six (6) residents. At 10:10 a.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. COMMON AREAS: The living room area which is equipped with a television and is furnished appropriately. Required documents were posted in the common area. The emergency telephone numbers are posted in the common hallway. At 10:53 a.m. smoke, fire door and carbon monoxide alarms were tested and functioned properly at the time of the visit. Medications will stored and locked in a cabinet adjacent to the tv area. The residents’ and staff files will stored and locked in a cabinet located in the open rest zone area adjacent to the living room. Activities were observed in the common areas. GARAGE /LAUNDRY: The garage is adjacent to the entrance with extra supplies and used as storage at the time of the visit. There is a laundry area equipped with a washer and dryer located inside the garage. Detergents and cleaning supplies are stored in the locked garage. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... KITCHEN: Kitchen knives are stored locked and inaccessible in a locked kitchen drawer. The facility has a sufficient supply of seven (7) day non-perishable food that was checked for proper labels and expiration dates. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional.Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 116.7 degrees Fahrenheit. Trash cans have a tight-fitting lids. There were no pesticides or toxins stored near food, or preparation area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. A fire extinguisher is located in the dining area, which was purchased on 06/12/2026. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. BEDROOMS: There are four (4) total bedrooms in the facility; Two (2) bedrooms are designated as private, single occupancy, resident rooms, and two (2) are designated as shared, double occupancy, resident rooms. All bedrooms were supplied with the required bedding and linens. There was sufficient lighting as well as closet and drawer space available. All window screens were clean and maintained in good repair. There is no staff room and Licensee representative stated that staff will remain awake at night. The emergency exiting plans/sketch are posted in every room. BATHROOMS: There are two (2) full bathrooms. One (1) common, shared resident bathroom, and one (1) private, resident bathroom. Bathrooms are equipped with toilet and shower grab bars, and slip resistant surface / mat. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water temperature was recorded between the range of 116.2 - 116.8 degrees Fahrenheit within the range. SURROUNDING GROUNDS/OUTDOOR AREA: The exterior passageways were relatively clean. The patio is furnished with outdoor furniture for residents’ use, and shade is available. The house has a central entrance for residents and visitors and also has a motor gate. Only one (1) passageway is used as an emergency exit which was free of obstructions at the time of the visit. The left passageway is cleared and has a self-latching gate. The self-latching mechanism is located inside the gate. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. RECORDS: During the visit LPA reviewed the facilities Administrator's file and Licensee representatives file. Both files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, and email address. Licensee Representative added a facility phone number and confirmed that all information is accurate. During todays visit the applicant completed Component III orientation. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating under the new license until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect the approval of your license. Pre-Licensing is complete. No citations issued. Exit interview was conducted and reviewed with the applicant. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jun 16, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 3 COMP II Participants: Angela Khacheryan CEO/ Varduhi Muradyan Administrator Interview Method: Telephone interview On May 27, 2026, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readiness 9. Pre-licensing Facility Grounds Inspection and Operational Readinessthe state’s words, verbatim · CDSS document, May 27, 2026