Loving Care for You

Type of visit: Prelicensing

On 7/1/2026, at 9:30AM, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an announced Pre-licensing visit. LPA met with the Administrator, Fichidzyan Aykanush and introduced herself by showing her department badge. An application was submitted to Community Care Licensing Division-CCLD on 11/12/2025, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The requested capacity is for five (5) non-ambulatory and one (1) bedridden, a total of up to six (6) residents. The fire clearance was approved on 12/11/2025. Structure: The facility is a single-story building with four (4) bedrooms, and four (4) bathrooms. There is a designated staff/office room. Hospice waiver requested for six (6) residents. Entrance: Upon entrance, required postings such as: Personal Rights of Residents, Long-Term Care Ombudsman, and See Something Say Something were observed. Common Areas: The common areas include: the living room and the dining room. The rooms were observed to be neat, clean, and organized with sufficient seating for both residents and staff. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature of seventy-six (76) degrees. No firearms were observed or will be maintained on the premises. LPA observed a working telephone to be located in the kitchen area. Resident/staff files: The resident and staff files will be kept inside the locked office/staff room. Residents won’t have access to the staff room. LIC809C-continued Bedrooms: The bedrooms were observed to be properly furnished with bed, nightstand, applicable lighting, and seating. Window coverings are in good repair, not broken or damaged. Bathroom: The bathrooms were observed to be in proper condition. Towels and washcloths will not be shared. Appropriate grab-rails and slip-resistant mats were observed and in proper condition. Hallways: The hallway was observed to be properly lighted. LPA observed extra linens/covers stored inside the hallway closet and inside each bedroom closet. Kitchen: The kitchen was observed to be equipped with sufficient supplies of dishes, cups, and silverware located within the kitchen cabinets and drawers. Sufficient supplies of seven (7) day nonperishable food were observed. Perishable food items are not required at this time as there are no residents in the facility. Sharps were observed to be stored in kitchen drawer, locked and inaccessible to the residents. The cleaning solutions and toxins were observed to be kept locked in cabinet underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. Medications: The medication will be stored in a locked cabinet located near the kitchen along with a First-aid kit. Medication storage was observed to be equipped with a lock to ensure medications will not be accessible to residents. Emergency: The Fire extinguisher was observed to be located near the kitchen and dated 11/13/2025. Laundry: The laundry appliances were observed to be located in a separate area near the kitchen. Dryer and washer were observed to be in proper condition. LPA observed cleaning solutions and toxins to be located and stored appropriately within a locked storage unit and inaccessible to residents. GARAGE: LPA observed detached garage. The garage will be used for storage. Emergency supply of food and water was stored and readily available. Water Temperature: The water temperature was measured in the bathrooms and observed to be within regulations 105.8 – 108.9F. LIC809C-continued Smoke detectors: The smoke detectors and carbon monoxide were observed to be working properly and were tested at 11:00 am. Outside: The outside was observed to be clean, free of hazards, and properly furnished with sufficient seating. No body of water was observed in the property. 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: 9/30/2027. 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.the state’s words, verbatim · CDSS document, Jul 1, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 06 Census : 0 Method: Telephone call with CAB COMP II Participants: AYKANUSH FICHIDZHYAN; AYRAPET FICHIDZHYAN Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee'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, May 28, 2026