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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850430
Report Date: 05/13/2026
Date Signed: 05/13/2026 07:21:29 PM

Document Has Been Signed on 05/13/2026 07:21 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:ANGELS HANDS SENIOR LIVINGFACILITY NUMBER:
195850430
ADMINISTRATOR/
DIRECTOR:		GHUKASYAN, MARINEFACILITY TYPE:
740
ADDRESS:14819 VALERIO STREETTELEPHONE:
(818) 679-4442
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 5DATE:
05/13/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Marine GhukasyanTIME VISIT/
INSPECTION COMPLETED:
07:25 PM
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At 09:55 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Marine Ghukasyan was contacted telephonically and the reason for the visit was explained. The Administrator arrived shortly thereafter.

At 10:20 a.m. the LPA conducted a tour of the physical plant with the Administrator to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: The home is a single story family home consisting of a living room, dining room, family room, kitchen, 3 resident bedrooms, one office/staff room, 2 full bathrooms and a attached garage. The LPA observed fire extinguishers at the home, which were fully charged and last serviced 09/19/2024. All smoke alarms and carbon monoxide detectors were tested, and functioned properly. The LPA observed all required postings in the living room of the home.

Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; Sharp objects are stored in a locked drawer on the left side of the stove and cleaning supplies are stored in a in a locked cabinet under the sink. At 10:23 a.m. the LPA observed two food cabinets with locks, during the visit the locks were unlocked, however when questioned staff stated that they are locked at night due to a resident removing the food at night. Locks were removed during the visit.

Report will continue on LIC809-C, 2nd page.
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Esther Cortez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2026
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: ANGELS HANDS SENIOR LIVING
FACILITY NUMBER: 195850430
VISIT DATE: 05/13/2026
NARRATIVE
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Bedrooms: All resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. At 10:32 a.m. the LPA observed a door lock latch in room #2 on the door leading outside near the top. The LPA could not unlock it without the assistance of staff. Door lock was removed during the visit.

Bathrooms: The LPA observed all bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. At 10:47 a.m. water temperature in resident’s restroom was measured at 112.5 degrees Fahrenheit.

Common Areas: These included the living room, family room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in between the living room and family room, which is covered with a screen. There were no obstructions and/or tripping hazards throughout the inside of the facility. At 11:30 a.m. the LPA observed a door lock latch on the front door. Lock was removed during the visit.



The garage: The LPA observed the garage where additional supplies and the emergency water is stored. Cleaning supplies and disinfectants are kept in the garage. The garage is locked.

Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. At 10:59 a.m. the LPA observed the outdoor wooden walkway outside of room #2 with multiple boards uneven with visible gaps between them, some boards appear loose, and a few sections look sunken.

Record Review: At 12:07 p.m. a review of facility files was initiated. The LPA reviewed five (5) out of five (5) resident files. The LPA observed documentation of Infection Control, Disaster prevention and last Disaster drill (conducted on 03/14/2026). The LPA advised to conduct disaster drills for every shift. The LPA obtained Client Roster, Staff Roster, and Insurance Liability. The LPA reviewed five (5) out of five resident files and four (4) out of four staff files. All documents reviewed appeared complete and current.

Interviews: The LPA conducted three (3) resident Interviews. No immediate concerns were voiced.

Report will continue in LIC809-C, 3rd page.
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Esther Cortez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
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: ANGELS HANDS SENIOR LIVING
FACILITY NUMBER: 195850430
VISIT DATE: 05/13/2026
NARRATIVE
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Medications: At 3:00 p.m. a medications review was initiated for two out of five residents and the following was observed. The medications were stored in a locked cabinet in the kitchen and inaccessible to the residents. During Resident #1 (R#1's) audit, the following was observed: Loratadine 10 mg not documented on the Facility Centrally Stored Medication and Destruction Record (CSMDR), Insulin's instructions documented wrong, 2 units documented when its 16units, Lantus instructions documented wrong -16 units documented when its 15, and Pravastin's strength and quantity was not documented. During Resident #2 (R#2's) audit, the following was observed: Novolog was documented as Humolog according to the Administrator and documented as started but has not started medication and is still currently using Humolog. New order of Lantus was documented as started but not started and resident is still on the old order. Lorazepam medication filled in March is present but not being given or documented on the CSMDR, according to the Administrator it was discontinued but does not have a discontinued order and has not destroyed/discard the medication. At 3:58 p.m. the LPA observed Insulin pen with a needle, and observed staff dispense of the insulin pen needle in the kitchen trash can.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to Administrator.
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Esther Cortez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/13/2026 07:21 PM - It Cannot Be Edited


Created By: Esther Cortez On 05/13/2026 at 06:04 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: ANGELS HANDS SENIOR LIVING
FACILITY NUMBER: 195850430

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(a)
Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, the licensee did not comply with the section cited above in the wooden walkay outside of exit door in room #2 that is uneven with visible gaps creating a tripping hazard which poses an immediate health and safety risk to persons in care.
POC Due Date: 05/14/2026
Plan of Correction
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Administrator agreed to submit plan on how they will fix the walkway anbd submit plan by 05/14/26.
Type A
Section Cited
CCR
87303(f)(2)
Maintenance and Operation
(f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. (2) Syringes and needles are disposed of in accordance with the California Code of Regulations, Title 8, Section 5193 concerning bloodborne pathogens.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in one insulin pen needle that was thrown in the kitchen trash which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/15/2026
Plan of Correction
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The administrator agreed that they will conduct a mandatory, comprehensive in-service training session for all direct care staff regarding regulation 87303(f)(2) and will buy a sharps container to dispose of the needles safely and submit proof of purchase and training by POC Due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Esther Cortez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/13/2026 07:21 PM - It Cannot Be Edited


Created By: Esther Cortez On 05/13/2026 at 06:04 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: ANGELS HANDS SENIOR LIVING
FACILITY NUMBER: 195850430

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87608(a)(3)
Postural Supports
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in one resident's bed that was observed with a 3/4 bed rial and resident did not have a doctors order for bed rail which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/14/2026
Plan of Correction
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Bed rail was taken off during the visit. POC Cleared.
Type B
Section Cited
CCR
87468.1(a)(2)
87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in two food cabinets that were observed with locks, and staff admitted they lock them at night which posed a potential health and safety or personal rights risk to persons in care.
POC Due Date: 05/13/2026
Plan of Correction
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POC Cleared, locks were removed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Esther Cortez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/13/2026 07:21 PM - It Cannot Be Edited


Created By: Esther Cortez On 05/13/2026 at 06:23 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: ANGELS HANDS SENIOR LIVING
FACILITY NUMBER: 195850430

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87203
87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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Based on observation, the licensee did not comply with the section cited above in two exit doors (main entrance and door in room #2) that were observed with door lock latches and fire extinghishers that have not been serviced in over a year which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/20/2026
Plan of Correction
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Door locks were removed during visit, and visit to get fire extingher serviced was scheduled for 5/20/26. Administrator will submit proof of services to the fire extinghisers.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Esther Cortez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/13/2026 07:21 PM - It Cannot Be Edited


Created By: Esther Cortez On 05/13/2026 at 06:34 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: ANGELS HANDS SENIOR LIVING
FACILITY NUMBER: 195850430

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(a)(1)
87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.
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 one medication that was physically present but not being administered, staff stated medication was discontinued but no discontinued order was on file which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/18/2026
Plan of Correction
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Administrator agreed to obtain discontinued order or claification if the resident should be taking the medication from residents physician and document the medication, will submit dc order or clarification to LPA by POC due date.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Esther Cortez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2026


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Created By: Esther Cortez On 05/13/2026 at 06:39 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: ANGELS HANDS SENIOR LIVING
FACILITY NUMBER: 195850430

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(h)(6)(C)(E)(F)
87465 (h)The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (C) The drug name, strength and quantity.(E) The prescription number and the name of the issuing pharmacy. (F)Instructions, if any, regarding control and custody of the medication.
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 two medications that were not documented and three or more medications what were documented incorrect which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/27/2026
Plan of Correction
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2
3
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Administrator fixed all errors during the visit and initial the Centrally Stored Medication and Destruction Record and agreed to obtain medication training for all staff including themselves by a third party.
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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Esther Cortez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2026


LIC809 (FAS) - (06/04)
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