My Carefull Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan initially met with staff Garina Mirzakhanians who called the Administrator Rooben Ohanian for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. Administrator Rooben Ohanian arrived twenty (20 minutes later. A tour of the physical plant was conducted at 9:18 AM and the following was noted: There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. The facility is a single story house with a total of three (3) bedrooms and two (2) bathrooms. Fire cleared for six (6) non-ambulatory residents, one (1) of which may be bedridden on Room 1. Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 75°F. The smoke detectors are hardwired and interconnected and observed to be operational. There is a carbon monoxide installed at the facility. Fire extinguisher is located in the dining area and observed to be full and last inspected on 03/04/25. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. There is a tool shed on the side yard separated by a 5' gate and inaccessible to residents. (continued on LIC 809-C) (continued on LIC 809-C) SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a covered patio and backyard furniture to accommodate the residents. The Garage is converted into an office/staff break room/laundry area. There are drive way in front of the facility which could park three (3) cars at a time. Laundry area is located in the garage. Laundry detergents, cleaning agents and other toxins are stored in a cabinet in the laundry area, the garage was observed to be locked during visit. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured at 115.9°F. Towels and washcloths are not shared. There was enough clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. There is a complete first aid kits located in the kitchen. Client records: Client records are reviewed. Client records appear to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Disaster drill was last conducted on 10/20/25. Required posting observed in facility (complaint hot line poster). Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Nov 6, 2025

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Gary Tan and Angelica Segovia conducted a Pre-Licensing Inspection at this facility and met with the applicant representative Rooben Ohanian. The applicant is "My Carefull Home LLC". A fire clearance was approved on 05/29/24 for six (6) non-ambulatory residents, one (1) of which may be bedridden on Room #1. The applicant has an approved hospice waiver for six (6) residents. The facility is a single story house with a total of three (3) bedrooms and two (2) bathrooms. A tour of the physical plant was initiated at approximately 9:55 AM and the following was observed: KITCHEN: The facility has a Kitchen that is equipped with a refrigerator, microwave, stove, dishwasher and sink. There was an adequate supply of emergency food. Knives were observed locked in a kitchen drawer. Cleaning supplies and other toxins are stored in the cabinet below the sink which was locked during visit. BEDROOMS: There are three (3) bedrooms designated for clients' use, all are shared bedrooms. The applicant furnished the residents' bedrooms with beds, night stand, chairs, dressers, bedding and linen. The bedrooms have sufficient lighting and storage. BATHROOMS: The facility has two (2) shared bathrooms for clients' use. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured at a range of 110.7°F to 111.7°F. LAUNDRY ROOM: The laundry room is located in the converted garage. Laundry detergents and other cleaning agents were locked in a cabinet in the garage. The cleaning supply cabinet was observed to be locked during visit. (continued on LIC 809-C) (continued from LIC 809) COMMON AREAS: These included the living room and the dining area. Living room was furnished with chairs and side tables. The living room area was furnished with a television, a coffee table and sofas to sit the capacity of the facility. There were no visible immediate hazards. There is a working telephone line and internet access to residents. Dual smoke/carbon monoxide alarms were tested and observed to be operable, they are hardwired and interconnected. Fire extinguisher was last bought on 03/15/24 and located in the dining room area. The facility is equipped with closed circuit television system in the outside surrounding only. MEDICATIONS: The medication cabinet is located in the kitchen and has a locking mechanism. A complete first aid kit is located in the kitchen. Staff/Resident Records: Staff and resident records will be kept in the filing cabinet the converted garage/ office/staff break room. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a covered patio and backyard furniture to accommodate the residents. The Garage is converted into an office/staff break room/laundry area. There is a tool shed on the side yard separated by a 5' gate and inaccessible to residents. There are drive way in front of the facility which could park three (3) cars at a time. Component III was conducted with the Licensee representatives. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. Copy of this report.the state’s words, verbatim · CDSS document, Sep 26, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB COMP II Participants: Ohanian, Rooben On 9/9/24, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of 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 readinessthe state’s words, verbatim · CDSS document, Sep 9, 2024