195850423-8-19-2026-29-AS-QHUH-DX52X4-20260819174631

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850423
Report Date: 08/19/2026
Date Signed: 08/19/2026 05:47:03 PM

Document Has Been Signed on 08/19/2026 05:47 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 HILLS		FACILITY NUMBER:	195850423
ADMINISTRATOR/ DIRECTOR:	LILIT MNATSAKANYAN		FACILITY TYPE:	740
ADDRESS:	20461 VENTURA BLVD.		TELEPHONE:	(818) 346-9046
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY: 127		CENSUS: 89	DATE:	08/19/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:40 AM
MET WITH:	Lilit Mnatsakanyan - Executive Director		TIME VISIT/ INSPECTION COMPLETED:	06:00 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 Analysts (LPAs) Quoc Huynh and Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 09:40AM. LPAs met with Executive Director (ED) Lilit Mnatsakanyan and Business Office Director (BOD) Aurora Israelson. Entrance interview conducted. Beginning at 10:08AM, the LPAs, along with ED Mnatsakanyan and BOD Israelson, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: FACILITY LAYOUT: The facility is a five (5) story building, including an underground parking garage. There are sixty-two (62) private-use units throughout the assisted living (AL) levels and twenty-seven (27) units in the memory care (MC) level which is the entirety of the third floor. KITCHEN: At 10:08AM, LPAs observed the kitchen to have a sufficient supply of perishable and non-perishable food at the time of the visit. Appliances in the kitchen were clean and appeared functional. Snacks and beverages are available for residents. Food is prepared in the main kitchen, which is located on the first floor and is delivered to the common dining areas and MC Unit. Emergency water supply is stored in the locked laundry room in the basement. Report Continued on LIC 809-C

Kristin Heffernan
Quoc Huynh
	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

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: 08/19/2026

NARRATIVE

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BEDROOMS: The LPAs toured a total of twelve (12) randomly selected resident rooms. LPAs observed two (2) resident rooms in the MC Unit. Lighting in the rooms appeared adequate. The rooms were properly furnished and were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker.

BATHROOMS: LPAs observed the bathrooms to be equipped with grab bars near the toilet and shower/tub, and slip-resistant surfaces and mats in the shower/tub. LPAs tested hot water temperatures in resident bathrooms which were measured to be between 105.4-110.3 degrees Fahrenheit, which is within the required range.

COMMON AREAS: LPAs inspected the common areas throughout the facility including the Activity Room, Lobby, reading room, lounge, café, health center, theater, and salon. All rooms were furnished appropriately, and no immediate health and safety concerns were noted. The fire extinguishers are located on every floor in each building and were observed to be fully charged and serviced on 10/24/2025. There is a functioning telephone on the premises. Required postings were posted in the facility entryway and LPAs observed the Ombudsman Poster, DSS Complaint Poster, and emergency exiting plans/sketch posted in the hallways throughout the community. The signal system can be activated in the resident bedrooms and restrooms by a pull cord. At 10:47AM, LPA Barutyan pulled the signal cord in a resident restroom. After ten (10) minutes of waiting for staff response, LPA informed ED to have a staff member come clear the signal. Staff #1 (S1) arrived at 10:59AM, approximately twelve (12) minutes after pulling the pull cord, to clear the signal. Staff members stated that the resident was in the common area; ED explained to staff that signals should still be cleared regardless. LPA observed the signal system to be in working order. Staff provided clarification on signal clearing protocol to S1. Residents also have pendants they can wear to signal staff. All systems go directly to a central tablet and to hand-held devices. Designated staff carry a handheld device, which displays the location of the alarm that has been pulled. Staff also utilize walkie-talkies to communicate accordingly. There are two (2) delayed egress doors in the MC unit. LPAs tested one (1) delayed egress door at 11:05AM which was operational at the time of the visit.
Report Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

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: IVY PARK AT WOODLAND HILLS	FACILITY NUMBER: 195850423
	VISIT DATE: 08/19/2026

NARRATIVE

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The community’s smoke detectors and carbon monoxide detectors are hard wired and were last tested on 07/16/2026 by American Eagle Fire Protection and approved by the Los Angeles Fire Department.

OUTDOOR AREAS: LPAs toured the outdoor perimeter and observed self-latching gates. All exits were observed to be clear and free of hazards. There are several enclosed patios. No health and safety hazards observed.

MEDICATION REVIEW: Medications are locked and centrally stored in the medication office on the second floor and the MC unit medication room. Beginning at 4:06PM, medications for two (2) residents were reviewed for compliance. Both residents’ medications were not labeled and maintained on the centrally stored medication and destruction record.

RECORD REVIEW: Beginning at 4:05PM, five (5) resident and five (5) staff records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, personal rights, and first aid/CPR training. All resident and staff files reviewed were complete and were observed to be in compliance. During today’s visit, LPAs obtained a copy of the facility’s liability insurance.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: The LPAs reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted at least quarterly as required, with the last drill conducted on 07/12/2026.

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

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: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/19/2026 05:47 PM - It Cannot Be Edited

Created By: Quoc Huynh On 08/19/2026 at 05:16 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: 08/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87465(h)(4)

Incidental Medical and Dental Care Services

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in resident medication records were not maintained which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/26/2026
	Plan of Correction
1 2 3 4	The Licensee will provide staff with medication training through a third party vendor and provide a plan to oversee all medication protocols and provide proof to CCLD by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

LIC809 (FAS) - (06/04)

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