Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Tan conducted an Annual Required inspection of this facility today. LPA met with the House manager, Serge Petrosian and explained the reason for the visit. Per the house manager, they never had any client since opening and currently applying for vendorization at the North Los Angeles Regional Center (NLARC) Level III RCFE.

A tour of the physical plant was conducted at 9:39 AM and the following was noted:

There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan.

The facility is fire cleared for six (6) non-ambulatory residents one (1) for may be bedridden in room #1. Facility was also approved for a Hospice waiver for six (6) residents. The facility is a single storey building and has four (4) bedrooms and two (2) bathrooms currently with no residents. The facility dual smoke/carbon monoxide alarm system are hard wired and interconnected, tested and observed to be operational. The fire extinguisher is located by the dining area and was observed to be fully charged and last purchased on 09/14/25.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility and properly stored. Knives were stored in a locked drawer .

Bedrooms: All four resident rooms were properly furnished with appropriate beddings and linens with sufficient lighting. (continued on LIC 809-C)