Harmony House Care

Type of visit: Prelicensing

On 12/30/25, at 07:50am, Licensing Program Analyst (LPA) Gina Saucedo conducted an announced Pre-licensing visit. LPA met with Ani Martirosyan, Administrator. An application was submitted to Community Care Licensing Division-CCLD on 08/07/2025, 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, total of up to six (6) residents and fire clearance was approved on 09/25/2025-Room number three (3) is for bedridden. Structure: The facility is a single-story building with five (5) bedrooms and three (3) bathrooms. One (1) of the bedrooms has a private bathroom. The other two (2) bathrooms are in the hallway. Entrance: There is only one (1) entrance being utilized. There is a facility sketch, Personal Rights, Theft and Loss Policy against the wall, Yes sign. Toxins, cleaning solutions, and laundry detergents will be kept in the garage. Living/Dining area: The living room is neat, clean, and organized with sufficient seating for both residents and staff. The dining area is also neat, clean, and organized. Both areas are properly furnished and in good repair. The facility maintains a comfortable temperature of seventy-four (74) degrees. No firearms observed or will be maintained on the premises. LIC809C-continued Kitchen: Sufficient supplies of dishes, cups, and silverware located within the kitchen cabinets and drawers. Sharps are stored on the left side of the kitchen locked in one (1) of the cabinets. The kitchen appliances are working and are in good repair. First-aid kit is at the entrance of the facility. There is a working telephone on the premises. Emergency: There is one (1) extinguisher located in the living room. It is fully charged and dated 05/2025. Medications: Medication will be stored in the living room area in a one (1) of the pantry areas against the wall. Bedrooms: The bedrooms are properly furnished with bed, night stand, applicable lightening, and seating. Window coverings are in good repair, not broken or damaged. Bathroom: The bathrooms are in proper condition. The bathrooms have grab-bars and slip-mats. Hallways: Hallway is properly lighted. Extra linens/covers observed in a storage cabinet along the passageway. Staff room: There is no designated staff room. Water Temperature: The water temperatures were measured in the bathrooms at 113 and 114 Fahrenheit and are within regulations. LIC809C-continued Smoke detectors: Dual interconnected smoke detectors and carbon monoxide observed to be working properly and were tested. Garage: There is a garage detached from the house at the entrance of the facility. Outside: The outside is furnished with sufficient seating. A shaded area for residents/staff was observed as well. Pool: There is no pool and/or bodies of water. Cameras: There are cameras in the common area of the facility. Administration: The facility had submitted an Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan. The Component III Orientation RCFE was shown/reviewed with the Administrator/Licensee. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview conducted and copy of this report issued to the administrator.the state’s words, verbatim · CDSS document, Dec 30, 2025

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): COMP II Participants: ANI MARTIROSYAN/ADMINISTRATOR/APPLICANT Interview Method: Telephone interview On 12/19/25, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. 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, Dec 19, 2025