197607892-4-13-2026-29-AS-TBYE-DT4V6U-20260413161008

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607892
Report Date: 04/13/2026
Date Signed: 04/13/2026 04:10:48 PM

Document Has Been Signed on 04/13/2026 04:10 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:	CHRISTINE'S RETREAT		FACILITY NUMBER:	197607892
ADMINISTRATOR/ DIRECTOR:	GEVORG MKRTCHIAN		FACILITY TYPE:	735
ADDRESS:	14712 KILLION STREET		TELEPHONE:	(818) 387-8572
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91411
CAPACITY: 6		CENSUS: 4	DATE:	04/13/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:29 AM
MET WITH:	Gevorg Mkrtchian		TIME VISIT/ INSPECTION COMPLETED:	04:15 PM

NARRATIVE

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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:29 AM. LPA met with facility staff and contacted the facility Administrator Gevorg Mkrtchian via telephone call. The Administrator arrived to the facility at 10:52 AM Entrance interview conducted and the reason for the visit was explained.

Beginning at 10:54 AM, the LPA and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured cabinet to contain knives and client medications. LPA observed a wall mounted fire extinguisher in the kitchen to be fully charged and serviced on 04/13/2026.

OUTDOOR SPACE: The facility has one (1) emergency exit gate, LPA observed clear passageways for emergency exit use. The facility had adequate shaded outdoor seating for client use. LPA observed the backyard to contain an appropriately secured shed which contained holiday decorations.

CONTINUED ON LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

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: CHRISTINE'S RETREAT	FACILITY NUMBER: 197607892
	VISIT DATE: 04/13/2026

NARRATIVE

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COMMON AREAS: This includes the living room, dining room, laundry room, and hallway. LPA observed the living room to be clean and properly furnished at the time of the visit. LPA observed the living room to contain appropriate seating and activities for client use. The dining room was observed to be clean and contained adequate seating for client use. LPA observed a cabinet in the dining area to contain unsecured lotions and medications that belonged to facility staff. LPA informed the Administrator who secured the items immediately at the time of the visit. LPA observed the facility laundry room adjacent to the kitchen. The laundry room was observed to contain a washer and dryer and a properly secured cabinet which contained detergents. The hallway was observed to contain a cabinet which contained extra linens and care supplies. Smoke detectors and carbon monoxide detectors were tested at 11:30 AM and were functional at the time of the visit.

BEDROOMS: There are four (4) bedrooms in the facility; three (3) are designated for client use and one (1) is designated as a staff room. All three (3) client bedrooms are dual occupancy rooms. LPA and the Administrator toured all three (3) client rooms. All client rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. The staff room was observed to be locked and inaccessible to clients in care.

BATHROOMS: There are two (2) bathrooms at the facility. One (1) is designated as a common client bathroom and one (1) is designated as a private client bathroom. Both bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. All grab bars observed were in good repair and were properly secured. The water temperature was measured in both bathrooms between 113.0 degrees Fahrenheit and 116.6 degrees Fahrenheit which is in compliance with regulation.

RECORD REVIEW: Record review began at 11:32 AM. Staff and client records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, client physician's report, needs and service appraisal, consent forms, and personal rights. Six (6) staff files were reviewed. All staff files contained all required documentation and trainings. Four (4) client files were reviewed. One (1) client file was observed to be contain an Appraisal Needs and Services Plan (ANS) created more than one (1) year prior. LPA informed the Administrator who agreed to complete an updated ANS for the identified client.

CONTINUED ON LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

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: CHRISTINE'S RETREAT	FACILITY NUMBER: 197607892
	VISIT DATE: 04/13/2026

NARRATIVE

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MEDICATION REVIEW / CASH RESOURCE REVIEW: Medication review began at 12:58 PM. Medications are stored centrally and securely in a locked cabinet in the kitchen. Medications for four (4) clients were observed. All medications reviewed were documented properly on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Cash resource review was conducted for four (4) clients. All cash resources were appropriately stored and documented. No deficiencies were observed during cash resource review.

INFECTION CONTROL / EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. The facility’s emergency disaster drills are conducted quarterly and the last emergency disaster drill was conducted 04/01/2026. The facility’s emergency disaster plan and infection control plan are reviewed/updated by the facility Administrator annually.

INTERVIEWS: LPA interviewed two (2) staff members. The staff members interviewed were knowledgeable on their roles, responsibilities, personal rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. LPA interviewed one (1) client. The client interviewed had no concerns with the facility.

During today’s visit LPA obtained a copy of the facility’s updated resident roster, emergency disaster plan, and liability insurance. The Administrator agreed to send LPA an updated copy of the facility’s LIC 500.

The Administrator had to leave during the visit but has designated facility staff to sign this report on their behalf. 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: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/13/2026 04:10 PM - It Cannot Be Edited

Created By: Trevor Byrne On 04/13/2026 at 03:23 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: CHRISTINE'S RETREAT	FACILITY NUMBER: 197607892
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80087(g)

Building and Grounds

(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as a caregiver's bag which contained lotions and medication was unsecured and stored in an unlocked drawer in the dining room of the facility accessible to clients which posed an immediate health and safety risk to persons in care.
	POC Due Date: 04/13/2026
	Plan of Correction
1 2 3 4	Administrator secured the bag at the time of the visit. POC cleared.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 04/13/2026 04:10 PM - It Cannot Be Edited

Created By: Trevor Byrne On 04/13/2026 at 03:23 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: CHRISTINE'S RETREAT	FACILITY NUMBER: 197607892
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80068.3(a)

Modifications to Needs and Services Plan

(a) The licensee shall ensure that each client's written Needs and Services Plan is updated as often as necessary to assure its accuracy, but at least annually. These modifications shall be maintained in the client's file. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as one client's appraisal was dated 02/20/2025 and was not updated annually which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/27/2026
	Plan of Correction
1 2 3 4	Administrator agreed to complete an updated appraisal for the identified client and to send a copy of the updated appraisal to CCLD no later than POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC809 (FAS) - (06/04)

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