195850695-5-13-2026-29-AS-CYEE-DU32ZU-20260513175054

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850695
Report Date: 05/13/2026
Date Signed: 05/13/2026 05:51:17 PM

Document Has Been Signed on 05/13/2026 05:51 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:	PEACEFUL LIVING BOARD & CARE		FACILITY NUMBER:	195850695
ADMINISTRATOR/ DIRECTOR:	PETROSYAN, ARMAN		FACILITY TYPE:	740
ADDRESS:	14241 VALERIO ST		TELEPHONE:	(323) 872-9570
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY: 6		CENSUS: 0	DATE:	05/13/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:05 AM
MET WITH:	Arman Petrosyan, Administrator		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 Analyst (LPA) Christine Yee conducted an announced Prelicensing and Component III visit to ensure that the home meets Title 22 requirements and met with Arman Petrosyan, Applicant/Administrator. The facility is an Accessory Dwelling Unit located behind the main house with the address of 14239 Valerio Street. The front house is also going through the application process under the name of Golden Bridge Board and Care. The ADU is a single storey home consisting of a living room, dining room, a kitchen, 3 resident bedrooms and 2 full bathrooms. The facility has a sprinkler system and is fire cleared for 4 NON-AMBULATORY and 2 BEDRIDDEN residents. Bedroom #1 is designated for Bedridden use. Today's visit was conducted using the CARE Inspection Tool and the following was observed: The living room is furnished with seating for 6 residents, a coffee table, a mounted television and a television stand that is use for storage of board games. the dining room is furnished with a table and 6 chairs. Located in the dining is the only fire extinguisher that was purchased on 2/28/26 The kitchen is furnished with a stove, refrigerator, microwave, a coffee maker and toaster. Sufficient dinner ware, utensils, coffee cups and dessert plates were observed. Pots and pans for cooking were observed. Medications and sharp knives are stored in a locked cabinet under the kitchen counter and the cleaning solutions are stored under the kitchen sink. Continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
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)

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: PEACEFUL LIVING BOARD & CARE	FACILITY NUMBER: 195850695
	VISIT DATE: 05/13/2026

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.

Perishable foods for a minimum of 2 days will be purchased prior to accepting the first resident and additional non-perishable foods for a minimum of 7 days need to be purchased.
All three resident bedrooms are furnished with 2 twin beds, 2 chairs, 2 night stands, 2 lamps, and built in closets. Dressers meeting Title 22 requirements need to be purchased.
The required bed linens and pillows were observed on all the beds and extra linens were observed in the closet.
Curtains for privacy were observed
Sufficient bath towels, hand towels and 3 face towels were observed. Additional face towels need to be purchased in quantities to allow for changing.
The common bathroom and private bathroom located inside bedroom #1 is equipped with a walk in show, grab bars, slip resistant mat, a toilet and a single sink vanity. The private bathroom also has a shower chair. The water temperature in the private bathroom was tested and read 110.9 degrees and the water temperature in the common bathroom read 115.4 degrees Fahrenheit.
Hygiene products such as shampoos, conditioners, soap, tooth brushes, toothpaste were observed locked in the common bathroom cabinet under the sink.
The laundry closet located in the resident hallway contains a washer and dryer and detergents are locked in a cabinet.
The smoke detectors located in the resident bedrooms, hallway and the combination smoke/carbon monoxide detector in the living room were tested and were operational.
A first aid kit containing the required items and the first aid manual were observed
The auditory devices mounted on the outside exiting doors located in bedroom #1, back door and front door were tested an were operational.
Per tour of the backyard, a covered patio with a rattan love seat and 2 rattan arm chairs were observed. Two extra chairs are needed to accommodate 6 residents.
The trash cans stored in front of the property were observed.
Overall, the backyard and front yard were observed to be clean. Pieces of wood and plastic piping were observed along the left side of the home. Per Applicant, they are still working on the front house and the items will be removed.

Continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
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)

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: PEACEFUL LIVING BOARD & CARE	FACILITY NUMBER: 195850695
	VISIT DATE: 05/13/2026

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.

The following deficiencies need to be addressed:

additional face towels need to be purchased.
dressers meeting Title 22 requirements need to be purchased for all 3 bedrooms
additional non-perishable foods to meet the 7 day requirement needs to be purchased.
2 additional chairs are needed in the back patio.
review and update the Emergency Disaster Preparedness Plan
review and update the Infection Control Plan
post visiting hours

The following needs to be completed upon licensure:

Perishable foods for a minimum of 2 days will be purchased prior to accepting the first resident.
Purchase General Liability Insurance that meets Title 22 requirements
Create files for staff and residents with the required documents.

Component III was also conducted with Arman Petrosyan, Applicant/Administrator on today's visit.

Applicant will notify LPA Yee once the corrections have been completed by no later than 5/22/26.

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: 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)

Page: 4 of 4