Olive Nest

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit and met with the Applicant Liana Hakobyan, and Administrator Anna Hakobyan. This is a new facility application for a Residential Facility for the Elderly (RCFE) for six (6) non-ambulatory residents; one (1) of which may be a bedridden resident(s). Waiver was granted for hospice care for six (6) residents. Fire Clearance was approved on 08/16/2025. Bedridden approved in bedroom #1. At 10:55 a.m., the LPA, and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility will be following Title 22 Regulations. COMMON AREAS: The living room area is equipped with a television, and comfortable furniture in the sitting area for residents in care. There is a dedicated area for the posting of required documents in the hallway leading to the bedrooms. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Medications and files (residents and staff) will be stored in a locked cabinet located adjacent to the dining room area. Kitchen cleaning supplies will be stored and locked in cabinet adjacent to the dining room area. LAUNDRY: There is a laundry area equipped with washer and dryer. The washer and dryer are located in the hallway adjacent to bedroom # 3. Detergents and cleaning supplies will be stored in a locked cabinet on top of the washer and dryer. Continues on LIC 809C... KITCHEN: Kitchen knives are stored locked and inaccessible in a locked kitchen drawer. A seven-day supply of non-perishable food and water was available and located in the garage. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Hot water temperature was recorded at 115.7 degrees Fahrenheit. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. A fire extinguisher is located near the main entrance, and was purchased on 06/30/2025. BEDROOMS: There are five (5) bedrooms for residents in care and one (1) staff bedroom. Four bedrooms will be used as private rooms, and one bedroom #4 will be a shared room. Room #1 is approved for one (1) bedridden resident. All bedrooms are cleared for non-ambulatory. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available. An auditory device was observed in all residents’ bedroom doors. BATHROOMS: There are two (2) full bathrooms, with showers and one-half restroom designated for “Staff Only”. Bathrooms are equipped with toilets and shower grab bars, and non-skid mats. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water was delivered at 115.7 degrees Fahrenheit. SURROUNDING GROUNDS/OUTDOOR AREA: The exterior passageways were clean. The patio is furnished with outdoor furniture for residents’ use, and shade is available. The building has a central entrance for residents and visitors. An auditory device was observed in all residents’ bedroom doors which have an exit to the side/outdoors of the facility. The applicant completed Component III orientation. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Pre-Licensing is complete. Exit interview was conducted and reviewed with the applicant. A copy of the report was issued.the state’s words, verbatim · CDSS document, Dec 16, 2025

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care) Method: Telephone call with CAB COMP II Participants: Hakobyan, Anna On 10/17/2025, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. 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. 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, Oct 17, 2025