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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850251
Report Date: 10/25/2023
Date Signed: 10/25/2023 02:41:01 PM


Document Has Been Signed on 10/25/2023 02:41 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:VALLEY SENIOR CARE LIVING, INCFACILITY NUMBER:
195850251
ADMINISTRATOR:DANIELIAN, KHATCHIKFACILITY TYPE:
740
ADDRESS:8140 MATILIJA AVETELEPHONE:
(310) 666-2392
CITY:VAN NUYSSTATE: CAZIP CODE:
91402
CAPACITY:0CENSUS: 3DATE:
10/25/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Syeta Karapetyan, staffTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced visit to this location for the purpose of checking if the three (3) individuals residing at this location have been relocated per Notice of Operation in Violation of Law (NOVL) issued on 09/06/2023. At 2:15 p.m., the LPA met with staff and explained the reason for the visit. At 2:26 p.m., LPA Peraldi spoke with operator, Davit Hakobyan over the telephone. Davit Hakobyan was not able to meet the LPA during the time of the visit.

On August 28, 2023, operator Davit Hakobyan was notified that the licensure application for this property has been denied by Community Care Licensing’s (CCL) Centralized Applications Bureau. On 09/06/2023, Davit Hakobyan was informed and served a second Notice of Operation in Violation of Law (NOVL). An initial NOVL was served to Davit Hakobyan on June 16, 2023. Per the NOVL, Hakobyan was required to relocate all individuals requiring care and supervision within the 15 days of the NOVL. It was also explained to Davit Hakobyan that per Health and Safety Code 1569.16(b), re-submitting an application would not correct the citation, as an applicant does not have the right to re-apply for licensure for one year after the Department’s application denial.

During today’s visit, at 2:21 p.m., the LPA conducted a physical plant tour and observed three (3) individuals residing at the facility that require care and supervision. Two (2) out of three (3) individuals were out of the facility during the time of the visit.

On this day, 10/25/2023, the Department has assessed operator Davit Hakobyan Civil Penalties of $3,00 for failure to cease operation at the time of this visit ($200/day x 3 individuals x 5 day, 10/21/2023-10/25/2023 = $3,000. Total of $3,000).

Continued on LIC 809-C.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023
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: VALLEY SENIOR CARE LIVING, INC
FACILITY NUMBER: 195850251
VISIT DATE: 10/25/2023
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At 2:26 p.m., LPA Peraldi spoke with Davit Hakobyan over the telephone. During the telephonic conversation, Davit Hakobyan acknowledged and understood the Departments Civil Penalties. Davit Hakobyan explained that he is still finding proper placements for the (3) individuals. Davit explained that one individual left but is not certain if the individual officially moved out. Davit stated that the individuals will be properly relocated by end of the week and will provide the LPA with details. The LPA reminded Davit Hakobyan that unless all individuals are relocated from this location, civil penalties will continue to accrue at $200/day from today for each individual not relocated.

Exit interview conducted with staff. Davit Hakobyan was not available to sign the report, however staff were authorized to sign.

A copy of this report, civil penalties and appeal rights was emailed to Davit Hakobyan.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC809 (FAS) - (06/04)
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