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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850385
Report Date: 07/09/2025
Date Signed: 07/09/2025 07:36:14 PM

Document Has Been Signed on 07/09/2025 07:36 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:CARE OF HEARTFACILITY NUMBER:
195850385
ADMINISTRATOR/
DIRECTOR:		SARGSYAN, MAYAFACILITY TYPE:
740
ADDRESS:14625 LEADWELL STREETTELEPHONE:
(818) 983-7224
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 4DATE:
07/09/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:12 PM
MET WITH:Marina Martirosian, StaffTIME VISIT/
INSPECTION COMPLETED:
07:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit due to deficiencies observed on today's visit. LPA Yee met with Marina Martirosian, Staff. Also present at the facility was Svetlana Martirosian, staff's mother. She does not have a criminal record clearance. Multiple attempts were made via telephone to reach Alexander Otiashvili, Administrator/Licensee and all attempts were unsuccessful. The reason for the visit was explained.

Upon arrival at the home to conduct the initial investigation for a complaint, LPA Yee was informed by staff that Alexander Otiashvili was not at the facility and they could not do anything without him. LPA Yee was asked to return another day. LPA Yee was then told that the facility did not have any electricity and has not had electricity since Saturday, July 5, 2025. The reason provided for the electricity outage is because the facility did not pay their electric bill and the power was shut off. A health and safety check was conducted. A tour of the facility was conducted to observe the 4 residents in care and to determine if there were any immediate issues to be addressed. Resident #1 was observed sitting on their bed and LPA was initially told that they did not feel the heat but later indicated that the room was hot. All the residents had pizza for lunch and cookie and ice cream for a snack. Resident #2 and Resident #3 were laying in bed with the use of their oxygen. Per both residents, they were okay and was not feeling the heat. Resident #4 was also observed laying in bed and was comfortable with the heat early in the visit but was later observed wiping perspiration from their forehead later in the afternoon, but was not observed distressed. The mattress was observed inflated. Staff was advised to ensure that the residents get lots of water and wet towels to cool them down.
Per tour of the facility, an extension cord was observed coming in from the window into bedroom #3 from the
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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.

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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: CARE OF HEART
FACILITY NUMBER: 195850385
VISIT DATE: 07/09/2025
NARRATIVE
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the home of the neighbor to the right. Extension cords and electrical strips leading from bedroom #3 were observed in bedroom #2 and along the hallway to the kitchen. Resident #2 and Resident #3 oxygen tanks, Resident #4' inflatable mattress and the kitchen refrigerator were all hooked to the extension cords and electrical strips. None of the residents are on any medications that need refrigeration.
The food supply was also reviewed and perishable foods and non-perishable foods were observed for 4 residents and should be supplemented to last 2 days for perishables and 7 days non-perishables for 6 residents and staff. The water temperature was also tested in the common bathroom and it read 93.8 degrees Fahrenheit since the facility has tankless water heaters.. The temperature in the home read 90.6 degrees Fahrenheit. The kitchen gas stove was operational but needed to be lit manually. The home was without electricity from 7/5/25-7/9/25 and the Licensee failed to report the power outage to the Department.

Any deficiencies not addressed on today's visit, will be addressed on a return visit.

With the assistance of the Department and the Landlord, the electricity was restored around 5:24pm

Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Civil penalties were assessed from 7-5-25 through 7/9/25 at $100 per day for each day for at total of $500 that the licensee did not provide the required notification, Appeals Rights were discussed and a copy provided.

Marina Martirosian, Staff, was also advised to have the Licensee/Administrator contact the Department as soon as possible, but no later than 7/10/25.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2025 07:36 PM - It Cannot Be Edited


Created By: Christine Yee On 07/09/2025 at 06:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CARE OF HEART
FACILITY NUMBER: 195850385

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/10/2025
Section Cited
CCR
87303(b)(2)

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Maintenance and Operation: A comfortable temperature for residents shall be maintained at all times.The facility shall cool rooms to a comfortable range, between 78 degrees F(26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature
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The property owner contacted the Dept. of Water and Power to coordinate the restoration of electricity to the property by COB on 07/09/2025. The licensee shall show proof of payment to DWP on 07/11/2025 and payment plan confirmation to LPA by COB 07/11/2025.
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facility has had no electricity since 07/05/2025 and temperatures inside the facility were noted at 90.6 during today's visit, which poses an immediate health, safety or personal rights risk to the residents in care.
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Note: power was restored at 5:24pm on 7/9/25
Type A
07/10/2025
Section Cited
CCR87303(e)(2)

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Maintenance and Operation: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105
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The property owner contacted the Dept. of Water and Power to coordinate the restoration of electricity to the property by COB on 07/09/2025. Once the power is restored, the licensee representative will ensure the water heater is operable and temperatures are within allowable range.
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degree F (41 degree C) and not more than 120 degree F (49 degree C). facility has had no electricity since 07/05/2025 and the tankless water heater is inoperable without electricity. Hot water temperature measured at 93.8 degrees Fahrenheit during day’s visit which poses an immediate risk to the health, safety or personal rights to the residents in care.
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 Photographic proof of the temperature shall be sent to the LPA by COB 07/10/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2025


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Document Has Been Signed on 07/09/2025 07:36 PM - It Cannot Be Edited


Created By: Christine Yee On 07/09/2025 at 06:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CARE OF HEART
FACILITY NUMBER: 195850385

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/10/2025
Section Cited
CCR
87355(e)

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Criminal Record Clearance (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility. Based on record review, the licensee did not comply with the
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Licensee representative will send to family member to be fingerprint cleared and associated. The individual will not return to the facility until this is complete and proof has been sent to the LPA by COB 07/10/2025.
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section cited above as it was confirmed the facility has a family member, Svetlana Martirosian, present that has no criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
07/10/2025
Section Cited
HSC1569.686(a)(5)

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Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception: A utility company has sent a notice of intent to terminate electricity, gas, or water service on the property within not
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The property owner contacted the Dept. of Water and Power to coordinate the restoration of electricity to the property by COB on 07/09/2025. The licensee will notify the LPA immediately of the power restoration no later than 07/10/2025.
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more than 15 days of the notice.Based on observation, the licensee did not comply with the section cited above as it was confirmed the facility has had no electricity since 07/05/2025 due to non-payment to the LADWP. Civil penalty is hereby assessed for $500 for failure to comply
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****Power was restored during this visit****
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2025


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