195850689-8-3-2026-29-AS-CYEE-DWGVN4-20260730163433

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850689
Report Date: 07/30/2026
Date Signed: 08/03/2026 08:48:16 PM

Document Has Been Signed on 08/03/2026 08:48 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:	GOLDEN BRIDGE BOARD & CARE		FACILITY NUMBER:	195850689
ADMINISTRATOR/ DIRECTOR:	BALASANYAN, ANAHIT		FACILITY TYPE:	740
ADDRESS:	14239 VALERIO ST.		TELEPHONE:	(323) 687-7779
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY: 6		CENSUS: 0	DATE:	07/30/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:03 AM
MET WITH:	Anahit Balasanyan, Applicant		TIME VISIT/ INSPECTION COMPLETED:	04:40 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 announced Prelicensing and Component III visit to ensure that the facility meets Title 22 requirements and met with Anahit Balasanyan, Applicant/Administrator. Also participating in today's visit was Arman Petrosyan, Staff. The facility is a single storey family home consisting of a living room, dining room, kitchen, 6 bedrooms of which one is designated as a office/staff room and may not house any residents, 4 full bathrooms and a attached garage. The facility is equipped with a sprinkler system and is fire cleared for 3 NON-AMBULATORY and 3 BEDRIDDEN residents. Bedroom #2 and Bedroom #5 are the designated rooms for Bedridden use. Located on the same property is an ADU that is also licensed by the Department as an RCFE. Today's visit was conducted using the CARE Inspection Tool. The following was observed during today's visit: Bedroom #1, Bedroom 3, Bedroom #4 and Bedroom #5 are private rooms and are furnished with a bed, a night stand, a lamp, a chair, a dresser and a built in closet. Bedroom #2 is a shared room and is furnished with 2 beds, 2 night stands, 2 lamps, 2 chairs and a dresser and a built in closet. Window dressings were observed on all the bedroom windows and on the sliding glass door located in bedroom #2 and glass door in bedroom #5. bed linens - comforter, blanket, flat sheet, fitted sheet and a mattress cover were observed on the continued on LIC809-C

Kristin Heffernan
Christine Yee
	DATE: 07/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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)

Page: 2 of 4

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: GOLDEN BRIDGE BOARD & CARE	FACILITY NUMBER: 195850689
	VISIT DATE: 07/30/2026

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
26
27
28
29
30
31
32

Page 2.

residents bed. Extra sets of sheets, blankets and towels were observed in the residents' closet.
The four common bathrooms - one located by bedroom #1, one located by the staff office, one located by bedroom #4 and one located by the laundry room were all equipped with a walk in shower, a toilet and a single sink vanity. The 2 bathrooms located by the resident rooms and the 1 located by the staff office were also equipped with a shower chair, grab bars and a slip resistant mat. The bathroom located adjacent to the laundry room is designated for staff use had no grab bar or slip resistant mat. Hygiene products were observed stored in a locked cabinet under the bathroom sinks. The water temperature tested in the common bathroom located by the front bedrooms read 119.5 degrees, the water temperature in bathroom locate by office read 118.5 degrees and the bathroom by the back bedrooms initially read 103.5 degrees and was retested at 3:44pm and it read 108.2 degrees Fahrenheit.
The living room and the front lobby were furnished with leather sofas, armchairs and coffee table for the residents use. Wall mounted televisions were also observed. A large television console was observed in the living room.
The Kitchen is equipped with a stove/oven, microwave and a refrigerator. Non-perishable foods for a minimum of 7 days were observed in the kitchen cabinets. Perishable foods for a minimum of 2 days will be purchased and maintained on the premises prior to the acceptance of the first resident. Chinaware, cups and utensils for 6 residents and pots and pans were observed.
Night lights were observed in the resident rooms and in the resident hallways.
Fire rated doors were observed on bedroom #2, #5 and the 2 hallway entrances and the magnet was activated during the testing of the hardwired smoke detectors and the combination smoke/carbon monoxide detectors. Combination smoke/carbon monoxide detectors are located in the front resident hallway and in front of the office.
The auditory devices mounted on all the 5 outside exiting doors - Bedroom #2, Bedroom #5, front door, kitchen door and the back door were all operational
The only fire extinguisher located in the kitchen was purchased on 2/28/26
The first aid kit containing the required tweezer, scissors, thermometer, dressing and gauze were observed. A first aid manual was also observed.

continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: GOLDEN BRIDGE BOARD & CARE	FACILITY NUMBER: 195850689
	VISIT DATE: 07/30/2026

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
26
27
28
29
30
31
32

Page 3.

Cleaning solutions, disinfectants, dish soap and other toxins are currently stored in a locked cabinet under the kitchen sink.
the facility has internet and a tablet dedicated for resident use.
the centrally stored medications will be stored in a locked kitchen cabinet.
the laundry room located, adjacent to the kitchen was observed with a new washer and dryer.
per tour of the garage that is connected to the laundry room, it was observed to be used for storage.
the required postings were observed on the wall by the front door.
Per tour of the backyard, a table with 6 rattan chairs and an umbrella was observed for outside activity.
Per tour of the front, the trash cans were observed to be tightly sealed.
The outside and inside areas were observed to be clean and well maintained.

The following will be completed upon licensure:

General liability insurance meeting the required limits, $1 million per occurrence and $3 million total aggregate will be purchased once the facility license is issued.
A surety bond will be purchased in the appropriate amounts if the Applicant decides to handle resident funds or become a payee for residents' funds
create files for all residents, staff and volunteers with the required documents noted in Personnel Records and Resident Records
Purchase perishable foods for a minimum of 2 days prior to accepting the first resident.

COMPONENT III was completed with Anahit Balasanyan and Arman Petrosyan, Staff.

As of today's visit, the facility has been determined to meet licensing requirements.

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: 07/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026

LIC809 (FAS) - (06/04)

Page: 4 of 4