Graceful Aging Care

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jose Tan conducted a Pre-Licensing Inspection with the applicant representative Narine Bogosyan. The applicant is "Graceful Aging Inc.". A fire clearance was approved on 03/26/26 for six (6) non-ambulatory residents, one (1) of which may be bedridden on Room #2. The facility has a total of four (4) bedrooms and two (2) bathrooms. A tour of the physical plant was initiated at approximately 8:36 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 perishable and nonperishable food. Knives were observed locked in a kitchen drawer. Cleaning supplies and other toxins are stored in the cabinet in the garage which was locked during visit. BEDROOMS: There are four (4) bedrooms designated for client's use; two (2) private and two (2) shared. The applicant furnished the resident 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 116.4°F to 117.2°F. LAUNDRY ROOM: The laundry area is located in the garage. Laundry detergents and other cleaning agents were locked in a cabinet inside the garage. The garage 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 sofa to sit the capacity of the facility. There were no visible immediate hazards. Cleaning supplies and chemicals are stored and locked in a cabinet in the garage. There is a working telephone line and internet accessible to residents. Dual smoke/carbon monoxide alarms were tested and observed to be operational. Fire extinguisher was last bought on 03/06/26. SMOKE DETECTORS/CARBON MONOXIDE: All resident rooms are equipped with smoke detectors and the facility's smoke detectors are hard wired and interconnected. The carbon monoxide detector is located in a hallway leading to bedrooms. Detectors were tested by and were observed operational. MEDICATIONS: The medication cabinet is located in the kitchen and has a locking mechanism. A complete first aid kit is located inside the medication cabinet. Staff/Resident Records: Staff and resident records are kept in a filing cabinet located by the kitchen. 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 attached to the house, locked and inaccessible to residents and currently being used as laundry area and storage. There is no body of water in the facility. Component III was conducted with the Licensee Representative. No deficiencies were observed during visit. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 15, 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, Jun 29, 2026