195850507-2-5-2026-29-AS-CYEE-DR23SL-20260205173030

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850507
Report Date: 02/05/2026
Date Signed: 02/05/2026 05:30:51 PM

Document Has Been Signed on 02/05/2026 05:30 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:	S & S ADULT RESIDENTIAL FACILITY INC		FACILITY NUMBER:	195850507
ADMINISTRATOR/ DIRECTOR:	GHAZARYAN, YERANUHI		FACILITY TYPE:	735
ADDRESS:	6458 RADFORD AVE		TELEPHONE:	(323) 219-5454
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY: 4		CENSUS: 0	DATE:	02/05/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:26 AM
MET WITH:	Yeranuhi Ghazaryan, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:40 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 Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection. Upon arrival at the facility, it was observed to be unoccupied. Telephone contact was made with the Yerahuhi Ghazaryan, Administrator and LPA Yee was advised that the facility had no residents at this time. LPA Yee advised her that an annual inspection still needed to be conducted. Per the Administrator, the initial time provided for her arrival to conduct the visit would be around 12:30pm. However, she was able to contact Lilit Movsisyan, Co-Licensee/CEO to schedule visit. LPA Yee was let into the home at 11:05am. The reason for today's visit was provided. The facility is a single storey family home consisting of a living room, dining room, kitchen, 5 bedrooms of which one is used as an office, 3 full bathrooms and a detached garage. The facility is fire cleared for 3 AMBULATORY and 1 NON-AMBULATORY clients. The facility is also in the process of being vendorized by the North Los Angeles County Regional Center as a Level 3 home As of today's visit the facility does not have any clients or staff. Upon entry into the home, LPA Yee was informed by Ms. Movsisyan that they discovered that home had been burglarized on 2/4/26. The hygiene products, new bed linens and televisions in all the bedrooms and living room, the washer and dryer, microwave, toaster, office computer and files were stolen. The facility van was broken into and an attempt was made to take the vehicle but was unsuccessful. Other items were also broken by the burglars. continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026

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: S & S ADULT RESIDENTIAL FACILITY INC	FACILITY NUMBER: 195850507
	VISIT DATE: 02/05/2026

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The entire CARE Inspection Tool was reviewed, no staff or resident files were reviewed as the facility has not accepted any clients or hired staff. The primary focus on today's visit was the physical plant and the following was observed:

all four resident bedrooms are furnished with a queen size bed, a night stand, a lamp, a dresser and a built in closet except bedroom #4 has a portable closet.
The office was observed with a desk, a sofa, a computer and a printer.
2 sets of bed linens and towels were observed for each client in their dresser
the living room, dining and kitchen are furnished and equipped with the appropriate furniture and equipment. China ware for 4 clients were observed. Pots and pans were observed
the facility had some perishable and non-perishable foods on the premises but does not meet Title 22 requirements at this time since the facility does not have any clients. Licensee will ensure that perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days are purchased and maintained on the premises prior to accepting the first resident.
the front and back right common bathroom is equipped with a bath tub, a toilet and a sink and the back left bathroom is equipped with a walk in shower with a grab bar, a toilet and a sink. Slip resistant mats were observed in all three bathrooms.
the 4 fire extinguishers located in the following areas: living room, by front bathroom, kitchen and client hallway were all serviced today.
the facility has a surety bond in the amount of $5K
the first aid kit was reviewed and contained a scissors, a tweezer and a thermometer. A first aid manual was observed.
The hardwired smoke detectors located in all the client rooms, office, hall way, dinning room and living were tested and were operational except the one located in the office and outside the office. Both smoke detectors of which one could be a combined smoke/carbon monoxide detector were damaged by the burglars and is in the process of being replaced.
The backyard was observed with a table, four chairs and a umbrella
The garage is primarily used for storage and the facility vehicle
The backyard, front yard and along the sides of the home needs to be mowed and items such as plastic buckets, old chairs, water hoses, tables need to be stored away or discarded. Trees need to be trimmed.

Exit interview was conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026

LIC809 (FAS) - (06/04)

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