195850179-7-27-2026-29-AS-CYEE-DWE3GQ-20260727181444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850179
Report Date: 07/27/2026
Date Signed: 07/27/2026 06:14:57 PM

Document Has Been Signed on 07/27/2026 06:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	YMZ ASSISTED LIVING		FACILITY NUMBER:	195850179
ADMINISTRATOR/ DIRECTOR:	DURGARYAN, REBEKA		FACILITY TYPE:	740
ADDRESS:	6206 KLUMP AVENUE		TELEPHONE:	(818) 358-2955
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY: 6		CENSUS: 6	DATE:	07/27/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:42 AM
MET WITH:	Rebeka Durgaryan, Administrator		TIME VISIT/ INSPECTION COMPLETED:	06:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee was let into the home by Gulshair Iusupova, Staff. Staff contacted the Administrator via telephone and she arrived at 11:16am to conduct the visit. The reason for today's visit was provided. The facility is a single storey home consisting of a living room, dining room, kitchen, 3 bedrooms and 2 full bathrooms and a fenced in swimming pool. Located in the back of property is a separate 2 storey ADU. The facility has a fire clearance for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #1 is the approved room for bedridden use. On today's visit, all 12 domains of the CARE Inspection Tool was reviewed. LPA Yee also reviewed 6 resident and 8 staff files and conducted a tour together with the Administrator of the entire facility, inside and outside, on today's visit. The living room, dining room and kitchen had the appropriate furnishings and equipment for its designated use. The fireplace was covered with a fire screen and made inaccessible to the residents in care. Located inside the kitchen are the 2 fire extinguishers purchased on 3/15/26. Sharp knives are stored in a locked kitchen drawer, to the right of the stove. Sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed in the kitchen refrigerator, kitchen cabinets and the 2 refrigerators located in the covered patio located in the back. Drinking water was stored in the shed located by the swimming pool. The three resident bedrooms are shared rooms furnished with 2 hospital beds, 2 chairs, 2 night stands, continued on LIC809-C

Kristin Heffernan
Christine Yee
	DATE: 07/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: YMZ ASSISTED LIVING	FACILITY NUMBER: 195850179
	VISIT DATE: 07/27/2026

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2 lamps, 2 dressers in bedroom #1 and a single dresser in the remaining room and a built in closet.
The facility has 2 full bathrooms, of which one is a private bathroom located inside bedroom #2. The private bathroom is equipped with a toilet, a sink, a large tub and a walk in shower. Grab bars and a slip resistant mat was observed. The common bathroom is equipped with a sink, a toilet and a bathtub with a shower. Grab bars and a slip resistant mat was observed. The water temperature tested in the private bathroom read 112.6 degrees and the water in the common bathroom read 115.5 degrees Fahrenheit. The resident hallway does not have outlets for night lights. The hallway has a light fixture that is left on for lighting.
The residents beds were observed with mattress covers, fitted sheets, a blanket, some with flat sheets as per request of the residents. Extra linens were observed in the hall way closet.
The hardwired smoke/carbon monoxide detectors located in the resident hallway, dining room and living room and smoke detectors in the resident bedrooms were tested and were operational. The fire rated door was operational.
The cleaning solutions are stored in a locked cabinet under the kitchen sink and in a locked cabinet in the laundry room.
Medications are stored in a locked metal cabinet located in the dining room.
The facility has current general liability insurance with limits of $1 million per occurrence and $3 million total annual aggregate.
The first aid kit was reviewed and contained the required tweezer, scissors, dressings and a external thermometer. A first aid manual was observed.
The auditory devices located on four outside exiting doors - kitchen, bedroom #1, bedroom #2 and the front door were operational.
located in the back of the facility is a covered patio with a coffee table and chairs and 2 refrigerators.
located on the other side of the rod iron fence are 2 storage sheds.
The trash cans were observed located in the front.
Overall, the inside and outside of the facility were observed to be clean.

No deficiencies were cited on today's visit
Exit interview was conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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