Facility Evaluation Report

Licensing Program Analyst (LPA), Sandra Urena conducted subsequent visit to finalized the prelicensing visit, arrived at the facility at 9:45 a.m., and met with applicant Rebeka Durgaryan. This is an application for a Change of Ownership(CHOW). Facility has capacity for a total of six (6) non-ambulatory residents.

On 02/28/2023, conducted an initial pre-licensing visit. Licensing Program Analyst (LPA), Sandra Urena arrived at the facility at 11:25 a.m., and met with Applicant Rebeka Durgaryan. This is an application for a Change of Ownership(CHOW). Facility has capacity for a total of six (6) non-ambulatory residents. Fire Clearance was approved on 01/20/2023 for six (6) non-ambulatory residents only.

Pre-Licensing is complete with deficiencies resolved. During the inspection, the LPA, and Applicant

observed the following corrections resolved:

1. Emergency Exiting Plan was updated to reflect current staff.

2. Activity supplies were present with an activity program plan.

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

Exit interview was conducted and reviewed with applicant Rebeka Durgaryan. A copy of the report was