195850704-4-14-2026-29-AS-QHUH-DT5SMY-20260414140043

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850704
Report Date: 04/14/2026
Date Signed: 04/14/2026 02:01:01 PM

Document Has Been Signed on 04/14/2026 02:01 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:	CARING TOUCH HOME INC		FACILITY NUMBER:	195850704
ADMINISTRATOR/ DIRECTOR:	SAMVELYAN, ALLA		FACILITY TYPE:	740
ADDRESS:	14018 CALVERT STREET		TELEPHONE:	(818) 279-5448
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91401
CAPACITY: 6		CENSUS: 3	DATE:	04/14/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:08 AM
MET WITH:	Petros Bakalyan - Applicant Alla Samvelyan - Applicant		TIME VISIT/ INSPECTION COMPLETED:	02:15 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) Quoc Huynh conducted a pre-licensing visit to the above noted facility. At 10:08AM, the LPA met with Applicants Petros Bakalyan and Alla Samvelyan. Entrance interview conducted. An application to operate a Residential Care Facility for the Elderly was submitted on 10/21/2025. A dementia program was included in the plan of operation. A Hospice Waiver for six (6) was requested. The facility's fire clearance was approved on 01/07/2026 for a total of six (6) residents: two (2) ambulatory, three (3) non-ambulatory, and one (1) bedridden. Component II orientation was completed on 03/11/2026. Component III was completed with the Applicants during today's visit. Beginning at 10:11AM, a physical plant tour was conducted. The following was observed: KITCHEN: Knives were stored in locked drawers. The supply of dishes, utensils, pots, pans and drinkware was adequate. The freezer was maintained at 0F and the refrigerator was maintained at 40F. The supply of perishable and nonperishable foods was adequate. There were no pesticides or toxins stored in any food storage area or preparation area. Appliances in the kitchen were clean and functional, however a lock was observed on the refrigerator. Report Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

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: CARING TOUCH HOME INC	FACILITY NUMBER: 195850704
	VISIT DATE: 04/14/2026

NARRATIVE

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BEDROOMS/BATHROOMS: The facility had five (5) bedrooms. Bedrooms #1 and #2 had direct exits to the outside and cleared for non-ambulatory residents with one (1) bedridden in Bedroom #1. Bedrooms #3 and #4 were approved for ambulatory residents and Bedroom #5 was designated for live-in staff that was not secured. Resident rooms were set up with beds, nightstands, lamps, and closet space. Bedrooms did not have required chairs and Bedroom #3 did not have sufficient clothing/storage space. The beds were furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, and blanket (if needed). Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. There were three (3) bathrooms: two (2) shared and one (1) private. The bathrooms have non-slip mats but in need of secured grab bars. The hot water temperature was tested and measured within the required range of 105*F to 120*F.

COMMON AREAS: The living room was appropriately furnished with a screened fireplace, and the lighting was adequate. Dining room furniture was in good condition and accommodated for all residents. There was a television, and/or activity supplies in the common areas. First aid kit was observed to be complete, including a thermometer and a current version of a first aid manual. There was sufficient space to accommodate both indoor and outdoor activities. The physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included but not limited to flashlights. Nightlights were observed throughout the common areas. The facility has central heating and air conditioning to maintain rooms to a comfortable temperature. At 10:41AM, the smoke and carbon monoxide detectors were tested and functioned properly. The dining room fire door was observed to have a lock and the LPA advised to switch the doorknob with the staff room. One (1) fire extinguisher was fully charged and purchased on 08/06/2025. A supply of extra bed linens were observed in the hallway cabinets. There is a washer and dryer closet located in the hallway and observed to be in good condition. There is a functioning telephone on the premises. All required postings are posted near the entrance.

Report Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

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: CARING TOUCH HOME INC	FACILITY NUMBER: 195850704
	VISIT DATE: 04/14/2026

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OFFICE/GARAGE: There was a secured office that contained residents’ centrally stored medications. It also led to the garage that contained emergency food and water, general storage, cleaning supplies, and extra hygiene products.

OUTDOOR AREA: The exterior passageways were clean and clear of any obstructions. Two (2) side gates led to the front yard/driveway which had an everyday use door and a remote and manual operated driveway gate. The LPA advised the Applicants to ensure the side gates remained unlocked at all times for emergencies. There were no bodies of water on the premises at the present time. There was a shaded patio area in the rear yard and a locked shed that was owned by the landlord.

The following corrections are needed prior to licensure:
- Remove the lock on the refrigerator
- Provide chairs for all Bedrooms
- Obtain dressers for Bedroom #3
- Install and ensure the sturdiness of grab bars in the bathrooms
- Unclog bathroom sinks to ensure proper drainage
- Switch fire door and staff door handles

The Applicant is to notify the LPA once corrections have been made, but no longer than 04/28/2026.

Exit interview conducted. A copy of the report was reviewed and issued.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

LIC809 (FAS) - (06/04)

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