College Town Senior Retirement Villa I

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility and conducted the visit with Administrator, Stephanie Molina. LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas. There is a pool on the premises made inaccessible to residents. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher were present. First aid kit were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff/clients and reviewed multiple staff and client records/files. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Administrator, Stephanie Molina to whom a copy of this report was provided during the visit.the state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPAs) Amy Rodgers , Angelica Boyles, Arian Golbakhsh conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations and Health & Safety Code. LPA was greeted by, identified themselves to, and explained the purpose of the visit to Applicant Anna Petrosyan Administrator Stephanie Molina. The facility fire clearance was granted on October 17, 2024 and reflects that the facility is approved for 6 residents, and that all 6 can be non-ambulatory. During today’s visit, LPA, accompanied by the applicant, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets and showers were in working order. The facility’s ambient internal temperature compliant .Water temperatures at taps for resident use were compliant. The facility has enough linens, hygiene supplies, dining supplies, and perishable and non-perishable food for future resident use. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of medication and confidential client and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Per the applicant, no firearms or ammunition are or will be stored at the facility. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC809] Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. 1 fire extinguisher and 1 complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6, Chapter 8 of California Code of Regulations and Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. Petrosyan and Molina were advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the applicant and administrator, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided at time of the visit. .the state’s words, verbatim · CDSS document, Feb 5, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB COMP II Participants: Petrosyan, Anna & Molina, Stephanie On 1/29/25, 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, Jan 29, 2025