Care Island

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Mariana Agban conducted a Pre-Licensing Inspection with Licensee/ Administrator Vigen Melkonyan. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on April 4, 2025. A fire clearance was approved on May 28, 2025, for five (5) non-ambulatory residents and one (1)bedridden resident, for a total capacity of six. The bedridden fire clearance is for room #4. A dementia plan of operation has been submitted. A hospice waiver has been requested for six (6) residents pending the Manager's approval. The smoke alarms and carbon monoxide detector are battery-operated and functional. The facility has fire extinguisher with a purchase date of 06/14/2025. The fire extinguisher is located in the kitchen. A tour of the physical plant was initiated at approximately 1:00 pm and the following was observed: KITCHEN: The facility has a Kitchen area equipped with a refrigerator, microwave oven, and sink. Adequate supplies of perishable and nonperishable food and dining ware accommodated a maximum capacity of six (6). BEDROOMS: There are four (4) bedrooms designated for residents' use. Bedrooms #1, and #3, are private rooms for non-ambulatory residents. Bedrooms #2 and #4 are shared. Bedroom#4 is a shared room bedroom with one (1) bedridden resident as per the fire clearance approval. The applicant furnished the resident bedrooms with beds, nightstands, chairs, dressers, bedding, and linen. The bedrooms have sufficient lighting and closet space. (Continue on 809C) BATHROOMS: The facility has two (2) bathrooms for the residents' use. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured 107.3 and 108.9 degrees. No cleaning supplies or hazardous items were present in each bathroom. COMMON AREAS: These included the living room and dining room. The living room was equipped with furniture, a television, couch, and table. The dining area has a large dining room table to accommodate six (6). There is a fireplace in the living room. It is screened, and there are no tools. There were no visible immediate hazards. There is a functioning telephone on the premises in the living room. There is also an office/workstation area in the living room. Medications will be kept locked in the office cabinets. Residents and staff files will be kept locked in the office cabinets. LAUNDRY ROOM/GARAGE: The washer and dryer are located in the garage. The garage is used as extra storage. Laundry detergents are kept locked in the garage and inaccessible to residents. SURROUNDING GROUNDS: The driveway, passageways, and entrance to the home were clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility's backyard has sufficient yard space. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 16, 2025

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Melkonyan, Vigen On 6/2/2025, 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, Jun 2, 2025