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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850542
Report Date: 07/09/2026
Date Signed: 07/09/2026 04:22:46 PM

Document Has Been Signed on 07/09/2026 04:22 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:ROSE GARDEN SENIOR HOUSINGFACILITY NUMBER:
195850542
ADMINISTRATOR/
DIRECTOR:		TONOYAN, LILITFACILITY TYPE:
740
ADDRESS:7526 TROOST AVENUETELEPHONE:
(818) 601-3232
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 6CENSUS: 3DATE:
07/09/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Hasmik 'Jasmine' KhachatryanTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 09:56 AM to conduct a case management-deficiencies visit at the facility today. LPA met with facility staff who contacted the Designee Hasmik 'Jasmine' Khachatryan. The Designee arrived to the facility at 10:07 AM. Entrance interview was conducted and the reason for the visit was explained.

During today’s visit, the LPA conducted a physical plant tour, conducted a file review for three (3) residents and one (1) staff member, obtained copies of pertinent documentation, and conducted a medication review for three (3) residents between approximately 10:15 AM and 02:40 PM.

During the physical plant tour LPA observed ongoing construction taking place in the back yard of the facility. LPA observed two (2) emergency exit doors attached to resident bedrooms that led to the backyard of the facility where construction was taking place. LPA observed auditory alarms installed on these doors which were not turned on and did not alert when the door was opened. LPA notified the facility staff and Designee who immediately turned on the alarms. LPA reviewed three (3) resident files and observed that one (1) resident was diagnosed with Major Neurocognitive Disorder. Additionally, LPA observed a ramp railing located at the front entrance of the home to be improperly secured. LPA notified the Designee who agreed to perform repairs to the identified railing.

CONTINUED ON LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2026
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: ROSE GARDEN SENIOR HOUSING
FACILITY NUMBER: 195850542
VISIT DATE: 07/09/2026
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During record review LPA observed one (1) resident who had full bed rails installed was not enrolled in hospice care. LPA informed the Designee that bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. The Designee agreed to remove the full bed rails from the identified resident’s bed. During the review of staff training records LPA observed staff training records to be missing the name of the trainer who conducted the trainings.

This report was read to the Administrator via telephone call. 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 was issued and appeal rights provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 07/09/2026 04:22 PM - It Cannot Be Edited


Created By: Trevor Byrne On 07/09/2026 at 03:26 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: ROSE GARDEN SENIOR HOUSING
FACILITY NUMBER: 195850542

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2026
Section Cited
CCR
87705(d)

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87705 Care of Persons with Dementia
(d) The licensee shall ensure that the facility has an auditory device... to monitor exits on exterior doors and perimeter fence gates...
This requirement is not met as evidenced by:
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Designee agreed to submit a statement of understanding confirming that the auditory alarms will stay on and active while construction is on going and while the facility retains any residents with major neurocognitive disorder/dementia.
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Based on observation the licensee did not comply with the section cited above as auditory alarms installed on doors leading to an active construction site on the property were not engaged which poses a potential safety risk to clients in care.
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Designee agreed to submit the statement to CCLD no later than POC due date.
Type B
07/23/2026
Section Cited
CCR87307(d)(4)

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87307 Personal Accommodations and Services
(d) The following space and safety provisions shall apply to all facilities:
(4) ...unless equipped with sturdy hand railings and unless well-lighted.
This requirement is not met as evidenced by:
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Designee agreed to have repairs to the railing performed to ensure that the railing is installed securely. Designee agreed to submit proof of the repairs to CCLD no later than POC due date.
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Based on observation the licensee did not comply with the section cited above as an entryway hand railing was not installed securely which poses a potential safety risk to clients 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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Trevor Byrne
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2026 04:22 PM - It Cannot Be Edited


Created By: Trevor Byrne On 07/09/2026 at 03:31 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: ROSE GARDEN SENIOR HOUSING
FACILITY NUMBER: 195850542

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2026
Section Cited
CCR
87608(a)(5)(B)

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87608 Postural Supports
(a) ...(5) ...
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care...
This requirement is not met as evidenced by:
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Designee agreed to remove the full bed rails from the identified resident's bed and to send proof of the removed full bed rails to CCLD no later than POC due date.
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Based on observation and record review the licensee did not comply with the section cited above as a resident who was not receiving hospice care had full bed rails installed which poses a potential personal rights risk to clients in care.
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Type B
07/23/2026
Section Cited
CCR87412(c)(2)(A)

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87412 Personnel Records
(c) Licensees shall maintain....
(2) Documentation of staff training shall include:
(A) Trainer’s full name;
This requirement is not met as evidenced by:
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Designee agreed to add the staff trainers name to all completed staff trainings and to send proof of the updated documents to CCLD no later than POC due date.
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Based on record review the licensee did not comply with the section cited above as staff trainings reviewed were missing the name of the trainer which poses a potential health, safety, or personal rights risk to clients 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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Trevor Byrne
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2026


LIC809 (FAS) - (06/04)
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