Love Is Us 1

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christine Yee conducted an announced Prelicensing and Component III visit and met with Ani Ghazaryan, Applicant/Administrator. Today's visit was conducted using the CARE Inspection Tool. The facility is a single storey family home consisting of a living room, dining room, kitchen, 3 bedrooms and 2 full bathrooms. The facility is fire cleared for six (6) NON-AMBULATORY residents only. Per the Applicant, she requested a hospice waiver for 6 residents. All 12 domains of the CARE Inspection Tool was reviewed on today's visit. Also reviewed were the Emergency and Disaster Plan for Residential Care Facilities for the Elderly and Residential Infection Control Plan. Component IIII was conducted with Ani Ghazaryan, Applicant/Administrator The following was observed on today's visit: The living room was observed with a L-shaped sofa capable of seating 6 residents, ottoman, mounted television and a television stand. Board games were stored in the ottoman. The dining room had a dining table and 6 chairs. Also observed in the dining room was the only fire extinguisher, purchased on 3/16/26. The kitchen is equipped with a gas stove with an oven, a dishwasher, refrigerator, microwave, toaster continued on LIC809-C Page 2. and coffee maker. Plenty of silverware, plates, cups and drinking glasses, pots and pans were observed. Sufficient non-perishable foods were observed for seven days and perishable foods for a minimum of 2 days will be purchased prior to accepting the first resident. Drinking water was observed in an outside storage shed located in the back. Water temperature tested in the kitchen read 107.6 degrees Fahrenheit. Medications will be centrally stored in a locked kitchen cabinet located by the food pantry. Also stored in the cabinet will be the first aid kit and manual. Cleaning solutions are stored in a locked cabinet under the kitchen sink, in the outside shed and in the locked cupboard located in the common bathroom. Bedroom #1 located on the left of the hallway, Bedroom #2 located to the right of the hallway and bedroom #3 located in the back left were all observed with 2 each: beds, night stands, lamps, chairs and one each: dresser and a built in closet. Each room is also equipped with a mounted television. Sufficient bed linens, blankets and towels were observed in the closets of each room. The bedroom windows were covered with blinds. The common bathroom is equipped with a single sink vanity, a toilet and a walk in shower. Grab bars were observed in the shower and behind the toilet. A slip resistant mat was also observed. Water temperature was tested and read 107.8 degrees Fahrenheit. The private bathroom is equipped with a 2 sink vanity, a walk in shower and a toilet. Grab bars and a slip resistant mat was observed. Water temperature was tested and read 107.6 degrees Fahrenheit. Located above the fire rated door from the living room and the resident hallway are hardwired carbon monoxide detectors. Smoke detectors also hardwired, are located in the 3 bedrooms. The smoke detectors and carbon monoxide detectors were tested and were operational. Auditory devices mounted on the 2 outside exiting doors located in the front and in the back were operational Per tour of the enclosed backyard, a table with 6 chairs were observed under a tent for outside activities. A storage shed was also observed. The enclosed backyard has a self latching gate on each side of the home. The gates are mounted with auditory devices. continued on LIC809-C Page 3. the trash cans were observed to be tightly sealed. the front yard is used for parking vehicles. The facility, backyard and front yard were observed to be clean and well maintained. The following needs to be corrected prior to licensure: the fire rated door needs to be adjusted so that it closes tightly when the smoke detectors are triggered a pair of scissors needs to be placed in the first aid kit the Emergency and Disaster Plan needs to be reviewed and updated to include more appropriate relocation sites and more details provided develop a facility policy for guns develop a facility policy for internet use post the facility's visiting hours update the facility sketch to include the assembly point and the locations of the gas, water and electric shut off valves. The Applicant will notify LPA Yee once the above corrections have been completed. The Applicant will also ensure to complete the following upon Licensure: purchase general liability in the amount of $1 million per occurrence and $3 million total annual aggregate create staff, volunteers and resident files as required by Section 87412 Personnel Records and Section 87506 Resident Records ensure that all staff have received a criminal record clearance and have requested a criminal record clearance transfer to the facility prior to being present at the facility Purchase perishable foods for a minimum of 2 days prior to accepting the first resident. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 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, Apr 24, 2026