Golden Path

Type of visit: Prelicensing

On 6/19/2026, at 09:30 AM, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an announced Pre-licensing visit. LPA met with the Administrator, Sahakyan Narine. An application was submitted to Community Care Licensing Division-CCLD on 02/20/2026, 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 04/30/2026. Structure: The facility is a single-story building with four (4) bedrooms and two (2) bathrooms. The facility is currently occupying five (5) residents. There is no designated staff room. Hospice waiver requested for five (5). 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-two (72) degrees. No firearms were observed or will be maintained on the premises. LPA observed a working telephone to be located in the dining room. Resident/staff files: The resident and staff files will be kept in locked storage closet located in the sun room, next to office desk area. Files will be kept in a locked cabinet inaccessible to Residents. LIC809C-continued Medications: The medication will be stored in a locked storage closet located near the living room 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. 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. Emergency: The Fire extinguisher was observed to be located near the kitchen and dated 4/2/2026. 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 in cabinet located inside the bathroom. Laundry: The laundry appliances were observed to be located in the garage. 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 that laundry machines are installed inside the garage, which will also 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 107.2F. LIC809C-continued Smoke detectors: The smoke detectors and carbon monoxide were observed to be working properly and were tested at 10:30 am. Outside: The outside was observed to be clean, free of hazards, and properly furnished with sufficient seating. LPA observed pool in the premises to be properly fenced and locked. 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: 12/10/2027. 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, Jun 19, 2026

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. 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. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, May 15, 2026