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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850423
Report Date: 09/24/2026
Date Signed: 09/24/2026 04:25:50 PM

Document Has Been Signed on 09/24/2026 04:25 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:IVY PARK AT WOODLAND HILLSFACILITY NUMBER:
195850423
ADMINISTRATOR/
DIRECTOR:		LILIT MNATSAKANYANFACILITY TYPE:
740
ADDRESS:20461 VENTURA BLVD.TELEPHONE:
(818) 346-9046
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY: 127CENSUS: 94DATE:
09/24/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Aurora Israelson - Business DirectorTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analysts (LPAs) Quoc Huynh and Angela Barutyan conducted an unannounced case management visit in conjunction with complaint #29-AS-20260526120211. The LPAs arrived at 12:50PM and met with Business Director (BD) Aurora Israelson and Health Services Director (HSD) Reina Rubi. Entrance interview conducted.

During today’s visit, the LPAs and HSD conducted a physical plant tour at 1:01PM. The LPAs observed the facility’s salon was under renovations and was accessible to residents in care as the door was unlocked. The salon was observed to have exposed wires, paint, and sharp objects. The HSD and BD stated that the door should have been locked and believed that the contractors had taken their break during this time. The salon was locked during the visit.

The complaint investigation revealed that the facility did not properly address the bed bug infestation in Resident #1’s (R1) room. Staff failed to follow treatment company instructions, did not fully clear the room of required items, and left R1 in the infested room without clothing for an extended period. The infestation persisted across multiple treatments, and both R1 and the Power of Attorney (POA) observed dead bed bugs and incomplete preparation even after the facility stated the room was ready. The Executive Director (ED) Lilit Mnatsakanyan declined to place R1 in available rooms, provided conflicting explanations about infestation risks, and relied on hotel relocation instead of implementing an adequate on-site solution.

Report Continued on LIC 809-C
Kristin Heffernan
Quoc Huynh
DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2026
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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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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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: IVY PARK AT WOODLAND HILLS
FACILITY NUMBER: 195850423
VISIT DATE: 09/24/2026
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Statements from the treatment technician confirmed the initial treatments were not completed properly and that R1 should not have been cleared to return on 05/25/2026. R1 returned to the community on 06/03/2026.

Upon returning to the community in a temporary room, R1 was not provided with adequate furniture, including a lamp, blankets, and bed linens. Staff reportedly laundered R1’s linens and clothing daily; however, linens were not consistently replaced or returned, with some being returned as late as 11PM. Photos provided to the Department showed R1 sleeping on an exposed mattress and on pillows without pillowcases. Due to insufficient lighting, R1 reportedly read their Bible in the restroom each night, as it was the only functional light source in the temporary room.

Additional incidents occurred during this period, including a popcorn-related smoke event in the common area that triggered the Los Angeles Fire Department’s (LAFD) response. Interview with additional residents confirmed the incident and described it as a “false alarm.” A medical emergency in approximately July 2026 resulting from R1 experiencing significant bleeding from a bite they scratched. On 08/19/2026, LPA Huynh observed blood splattered on the carpet of R1’s room, which the facility attempted to clean at R1’s expense. Per R1’s admission agreement, the resident is responsible for any damages to their room outside of “normal wear and tear;” however, R1’s incident was an unplanned medical emergency. Interview with the BD revealed that a maintenance request form was completed by staff who subsequently notified R1's Power of Attorney. The BD confirmed that a signed acknowledgement and addendum to the admission agreement for the service charge was not completed. The facility did not provide the Department with incident reports for either occurrence.

Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D).

A civil penalty in the amount of $250 was assessed for a repeat violation within a twelve (12) month period (Refer to LIC 421FC). The BD was advised that failure to correct and continued violation may result in additional civil penalties.

Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/24/2026 04:25 PM - It Cannot Be Edited


Created By: Quoc Huynh On 09/24/2026 at 01:53 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: IVY PARK AT WOODLAND HILLS
FACILITY NUMBER: 195850423

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/24/2026
Section Cited
CCR
87309(a)

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(a) ... the licensee shall ensure that ... tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement was not met as evidenced by:
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The staff secured the salon during the visit.
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Based on observation and interview, the licensee did not ocmply with the above section in the renovated salon was not secured and contained tools and sharp objects which posed an immediate safety risk to persons in care.
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Type B
10/15/2026
Section Cited
CCR87307(a)(3)

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(a) Living accommodations and grounds shall be related to the facility's function… provide comfortable living accommodations… (3) Equipment and supplies… shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:

This requirement was not met as evidenced by:
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The Licensee will obtain a sufficient supply of equipment and supplies and provide CCLD proof by POC due date.
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Based on interviews and record review, the licensee did not comply with the above section in R1 was not provided with required furniture or accommodation which posed a potential safety and personal rights risk to persons in care.
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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:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/24/2026 04:25 PM - It Cannot Be Edited


Created By: Quoc Huynh On 09/24/2026 at 01:58 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: IVY PARK AT WOODLAND HILLS
FACILITY NUMBER: 195850423

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2026
Section Cited
CCR
87211(a)(1)

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(a) Each licensee shall furnish to the licensing agency... including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency... within seven days of the occurrence of any of the events specified in (A) through (D) below…

This requirement is not met as evidenced by:
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The Licensee will provide the leadership team with training regarding reporting requirements and will provide CCLD proof by POC due date.
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Based on interviews and observation, the licensee did not comply with the above section in the facility did not provide written reports to the Department of incidents which posed a potential health, safety, and personal rights risk to persons in care.
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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:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/24/2026 04:25 PM - It Cannot Be Edited


Created By: Quoc Huynh On 09/24/2026 at 02:01 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: IVY PARK AT WOODLAND HILLS
FACILITY NUMBER: 195850423

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2026
Section Cited
HSC
1569.884(c)

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(b) A facility may assess a separate charge for an item or service only if that separate charge is authorized by the admission agreement. If additional services are available… that were not available at the time the admission agreement was signed, a list of these services and charges shall be provided to the resident or… representative. A statement acknowledging the acceptance or refusal to purchase the additional services shall be signed and dated by the resident or the resident’s representative and attached to the admission agreement.

This requirement was not met as evidenced by:
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The Licensee will confer with R1 and POA regarding the charges and will provide reimbursement if authorization is not granted. The Licensee will provide CCLD proof by POC due date.
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Based on interviews, observations, and record review, the licensee did not comply with the above section in the facility charged R1 a service that was not established in the admission agreement and did not document acknowledgement or a statement of the additional service which posed a potential personal rights risk to persons in care.
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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:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2026


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