Seniors Living Home

Type of visit: Required - 1 Year

At 11:55am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an annual inspection. LPA met with the Administrator and explained the reason for the visit. A tour of the physical plant was initiated at 12:00pm and the following was observed: The facility is cleared for five (5) Non-Ambulatory (in rooms #1, #2 and #3) and one (1) Bedridden resident in room #5. Hospice waiver for six (6) residents is also approved. Kitchen: The kitchen area is equipped with a refrigerator, microwave oven and sink. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives were observed to be locked in the kitchen drawer. The fire extinguisher was purchased on 07/16/2025. Medications and resident/staff files are kept in kitchen cabinet. There is a complete first-aid kit in the cabinet with all required supplies and with the first aid manual. Bedrooms: The facility has a total of six (6) bedrooms, five (5) of which are designated for residents use, one (1) room is designated for live-in staff. and three (3) bathrooms. The bedrooms are appropriately furnished with sufficient closet space and have sufficient lighting. All exit doors will have an auditory alarm. Bathrooms: Facility has three (3) bathrooms. Bathrooms have soap, paper towels and hand washing signs were observed. Bathrooms have soap, paper towels and all trash cans have a lid. Extra towels and linens were readily available. The hot water temperature measured at 111.7°F. Continue on LIC809-C The facility maintains a comfortable temperature of 77°F. LPA observed all common areas are furnished with adequate furniture to accommodate a maximum capacity of six (6) residents. There is a functioning telephone on the premises. Smoke detectors carbon monoxide is located throughout the facility and at 1:00pm they were tested and observed to be operational. Laundry Room: The laundry is located in the garage. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. Outside Areas: The back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for the residents. The outdoor area is free of visible immediate hazards. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. There is a swimming pool that is fenced with a gate that will be kept locked at all times. The fence installed to keep residents out of the swimming pool area is approximately 5 feet high throughout the parameters. You will need a key to unlock the padlock to gain entry to the swimming pool as it is kept locked at all times. Between 1:10pm to 2:00pm, LPA reviewed records of six (6) residents and three (3) staff. Resident and staff records appeared to be complete and updated. Resident’s files contain signed admission agreements and a medical assessment, and all other required documentarians. Annual fee is paid in full. LPA observed Administrator certificated renewed on 07/17/2025 with an expiration date of 07/16/2027. LPA collected Certificate of Liability Insurance and LIC500. No citations issued during this visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Sep 17, 2025

Type of visit: Prelicensing

On 8/14/2024 at 10:00AM Licensing Program Analyst (LPA), Perchui Milena Khurshudyan conducted an announced Pre-Licensing visit to the above facility and met with facility Licensee/Administrator Hakobyan Vram. Fire Clearance was approved on 04/08/2024 for a maximum capacity of six (6) residents, of which four (4) can be Non-ambulatory and one (1) Bedridden resident. Facility has Dementia Care Program. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22. The facility is a single-story building. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: KITCHEN: The facility has a Kitchen area that is equipped with a new refrigerator, microwave oven and sink. At 10:15AM, LPA observed adequate supplies of nonperishable food properly stored in the cabinets and inside the supply room. Perishable food items are not required at this time as there are no residents in the facility. Licensee will supply sufficient amount of perishable food upon arrival of the residents. LPA observed dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents in care. The facility has one (1) new fire extinguisher, appeared to be full and serviced and were last purchased on 03/05/2024. BEDROOMS: There are five (5) bedrooms designated for residents use. All bedrooms are furnished with beds, dressers, chairs, night stands and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational at 10:30AM.There is no bedroom designated for staff use. Facility will have awake staff at night. Emergency call buttons are available and will be provided to residents. Continue on LIC809C LAUNDRY ROOM: The laundry room is located in the garage, which is locked all the time. The washer/dryer appear to be new and in good condition. Laundry supplies along with other chemical items are kept locked inaccessible under supervision when not in use. BATHROOMS: Facility has three (3) bathrooms. At 10:45AM LPA observed all bathrooms are clean, in good repair and properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bars and non-skid mats in all bathrooms. Trash cans had closed tight fitting lids throughout. Water temperature was within regulation, and it was measured by an LPA at 10:45AM to be at 113°F degrees. Bathrooms #1 is designated for Staff and residents use. COMMON AREAS: The facility maintains a comfortable temperature at 78°F. The living room and dining area appeared clean and were properly furnished. The facility has separate activity room were puzzles, coloring books, crayons, board games and other activity supplies are available. No obstructions and or tripping hazards throughout the facility. An emergency exit plan/sketch is posted along the hallway with other posting requirements. Facility has fireplace in the living room which is locked and safe for residents in care. No fire-arms observed or will be maintained on the premises. MEDICATION ROOM: The medication will be centrally stored in the locked kitchen cabinet. Facility staff/resident files will be kept centrally stored and locked in the cabinet located next to the dining room. First-aid kit was checked to be complete and has the new manual available. Facility will have four (4) staff members, two (2) for each shift (AM and PM). SMOKE DETECTORS/CARBON MONOXIDE. Dual smoke detectors and carbon monoxide were located in the bedrooms and throughout the facility. At 11:00 AM they were tested and observed to be operational. Continue on LIC809-C SURROUNDING GROUNDS: The facility has gated entrance and sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The backyard is fenced. There is an attached garage which is currently being used for storage. LPA discussed the importance of maintaining the care and supervision to meet the needs of the residents. The property has properly fenced and locked pool, which is inaccessible to residents. The facility has land line located in the hallway area checked by an LPA to be operational. Component III was conducted with the Administrator. Based on inspection and observation, the physical plant is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and the applicant will be notified by the CAB Analyst when the license has been approved. Exit interview was conducted and a copy of this report was provided to the Applicant/Administrator.the state’s words, verbatim · CDSS document, Aug 14, 2024