Haskell House

Type of visit: Required - 1 Year

On 09/17/2025 at 8:10 AM, Licensing Program Analyst (LPA) Gina Saucedo and conducted an unannounced, Annual Inspection and met with Caregiver, Rosa Flores. Licensee was called and arrived about thirty (30) minutes, Marine Navruzyan, Licensee after and was advised of visit. LPA asked for the census, staff and resident files. The physical plant was toured inside and out at 9:55am. Living/Dining Room Area: LPA observed the living room furniture to be clean and in good repair. The facility maintains a comfortable temperature at 75 degrees Fahrenheit with a large television. There is enough seating for all residents to sit and eat. KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, stove, microwave oven and sink. There is an adequate supply of nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives were observed locked in a kitchen drawer on your left hand side. The medication is also kept in the kitchen on one (1) of the top drawers locked and inaccessible to the residents. BEDROOMS: There are six (6) bedrooms. Five (5) are designated for resident use. One (1) bedroom is reserved for staff. Bedroom #1 is a shared room. The other rooms are private, resident rooms. The bedrooms with have proper bedding, night stands/dressers, televisions, and linen. The bedrooms have sufficient lighting and closet space. LIC809C-continued BATHROOMS: The facility has three (3) bathrooms. Two (2) of the bathrooms are private used with it's own shower. The other bathroom is located in the hallway. All three (3) bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 107 and 108 degrees. There is no laundry room. The washer and dryer are located in the kitchen. Detergents and cleaning supplies are kept separately in a locked closet down the hallway. MEDICATIONS: The medications and medication records will be kept in a locked cabinet in the kitchen. OFFICE/STAFF BEDROOM: Staff office is located by the front entrance. Resident and personnel files will be maintained in a locked filing cabinet there. The staff bedroom is located by the dining room. ADMINISTRATION: The Liability Insurance was reviewed and will be renewed on 02/06/2026. There are several Personal Rights, Ombudsman, Resident Council, Theft and Loss, Family Council, Disaster and Fire Drill was last conducted August 01, 2025. There is also a signal system in the facility. There is one (1) fire extinguisher fully charged and dated July-2025. The carbon monoxide and the smoke detector were tested, and they were operable, interconnected. GARAGE: The garage is not attached to the home. It is located at the backyard. The garage is used for extra storage. There is a pool that is locked and inaccessible to the residents. There is a fence surrounded around the pool. An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the Licensee.the state’s words, verbatim · CDSS document, Sep 17, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant/licensee Marine Navruzyan, and administrators, Erna Vanoyan and Ani Navruzyan. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on February 12, 2024. A fire clearance was approved on September 9, 2024 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six. The facility is a one story building. The smoke alarms and carbon monoxide detector are dual and interconnected. The facility has one fire extinguishers that was purchased on July 13, 2024. It is located in the kitchen. A tour of the physical plant was initiated at approximately 10:00am and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and sink. There is an adequate supply of nonperishable food and dining ware to accommodate a maximum capacity of six (6). In addition to the nonperishable food items, the applicant keeps an emergency food supply in the pantry. No perishable food at this time, as there are no residents. Licensee was advised to keep a supply perishable food items when their license is obtained. Knives were observed locked in a kitchen drawer. BEDROOMS: There are six (6) bedrooms. Five (5) are designated for client use. One bedroom is reserved for staff. Per STD 850, Bedroom #1 has a bedridden fire clearance. Bedroom #1 is also a shared room. Bedrooms #2, #3, #4 and #5 are private rooms. The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has three (3) bathrooms. Bedrooms #1 and #4 has it's own bathroom with shower. The third bathroom is located in the hallway. All three bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 108 and 110 degrees. COMMON AREAS: These included the living room and dining room. The living room is furnished with a couch, coffee table and television. There is a fireplace that is screened, but non-operational. No fireplace tools present. The dining room table is large enough to seat up to six (6) residents. There is an additional couch located by the dining room. There were no visible immediate hazards inside of the facility. LAUNDRY ROOM: The laundry room is located next to the kitchen. The washer and dryer are brand new. Detergents and cleaning supplies will be kept separately in a locked closet. MEDICATIONS: The medications and medication records will be kept in a locked cabinet in the kitchen. OFFICE, STAFF BEDROOM & BREAKROOM: Staff office is located by the front entrance. Resident and personnel files will be maintained in a locked filing cabinet there. The staff bedroom is located by the dining room. Room was furnished with a bed and closet space. The kitchen had an additional table to seat up to four staff for their break. SURROUNDING GROUNDS: Passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. There is a swimming pool in the backyard surrounded by a six foot fence all around and a locked gate to deny resident access. The front yard has patio furniture appropriate for outdoor use and to accommodate the six residents. GARAGE: The garage is not attached to the home. It is located at the backyard. The garage will be used for extra storage. It will be kept locked and inaccessible to residents at all times. In addition to the Pre-Licensing inspection, a Component III power point presentation was held prior to the physical plant inspection. . Pursuant to Title 22, Division 6 of the CA Code of Regulations, the physical plant is compliant and the facility is ready for licensure. CAB will be advised and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 2, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Marina Navruzyan CEO/ Erna Vanoyan Administrator Interview Method: Telephone interview On September 10, 2024, 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 the 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, Sep 10, 2024