197608459-8-19-2026-29-AS-CYEE-DX53P3-20260819182452

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608459
Report Date: 08/19/2026
Date Signed: 08/19/2026 06:25:21 PM

Document Has Been Signed on 08/19/2026 06:25 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:	EMVY BOARD AND CARE FACILITY		FACILITY NUMBER:	197608459
ADMINISTRATOR/ DIRECTOR:	EMMA KOCHINYAN		FACILITY TYPE:	740
ADDRESS:	14164 COHASSET STREET		TELEPHONE:	(818) 947-1711
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY: 6		CENSUS: 3	DATE:	08/19/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:37 AM
MET WITH:	Emma Kochinyan, Administrator		TIME VISIT/ INSPECTION COMPLETED:	06:35 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 unannounced required Annual Inspection and used the complete CARE Inspection Tool. LPA Yee met with Emma Kochinyan, Administrator. The reason for today's visit was provided. The home is a single storey family home consisting of a living room, a dining room, a kitchen, a family room, 3 resident bedrooms, 2 bathrooms and a attached garage. The facility is fire cleared for 5 NON-AMBULATORY residents and 1 BEDRIDDEN resident. Based on the review of the rooms, Bedroom #3, located at the back right corner of the home, has an outside exiting door with a ramp and would be the room designated for bedridden use. All twelve domains of the CARE Inspection Tool, 3 Resident and 4 Staff files were reviewed on today's visit. A tour of the physical plant, inside and outside was also conducted. The following were observed: The living room, dining room, family room and kitchen were all furnished and equipped with the appropriate sitting for 6 residents, furniture and equipment for its designated use. The fire place located in the living room was observed with a fire screen. Bedroom #1 is currently rented as a private room, was observed with a bed, 3 armchairs, a night stand, a lamp, a dresser and a built in closet. The windows were observed with blinds for privacy. The second bed is stored in the attached garage. Bedroom #2 and Bedroom #3 were observed with 2 beds, 2 night stands, 2 lamps, 2 folding chairs a dresser and a built in closet. Also observed in bedroom #3 was an armoire. Half bed rails were continued on LIC809-C

Kristin Heffernan
Christine Yee
	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

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: EMVY BOARD AND CARE FACILITY	FACILITY NUMBER: 197608459
	VISIT DATE: 08/19/2026

NARRATIVE

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observed on all the hospital beds except a full bed rail was observed on the right bed in bedroom #2. Resident #3 is on hospice. Bedroom #3 also has a direct exit leading out to a ramp. Bedroom #3 is currently vacant and the Licensee agreed to remove all the bed rails. Written physician's orders indicating the need for the half bed rails were observed for bedroom #2 and written physician's orders for the use of bed rails in bedroom #3 will be obtained for the residents if the half bed rails are required and will be maintained in the residents' file.
Located inside Bedroom #3 is a full private bathroom. The bathroom has a walk in shower, a toilet and a single vanity sink. Grab bars were observed in the shower and by the toilet. A slip resistant mat was observed. The water temperature was tested and read 107.7 degrees Fahrenheit.
The common bathroom is equipped with a walk in shower, a toilet and a single sink vanity. Grab bars in the shower, by the toilet, a shower chair and a slip resistant mat was observed. The water temperature was tested and read 113.7 degrees Fahrenheit.
Sufficient perishable foods for a minimum of 7 days and non-perishable foods for a minimum of seven days were observed maintained on the premises.
Medications are centrally stored in a locked kitchen cabinet.
Extra Linens were observed in the hallway closet.
The hardwired smoke detectors in the resident rooms, living room and the one combination smoke/carbon monoxide detector located in the resident hallway were tested and were operational. The 2 fire rated doors located in resident hallway and bedroom #3 did not activate when the smoke detectors were triggered.
The auditory devices located on the front door, back door, kitchen door and bedroom #3 door were tested and were operational.
The facility has 2 fire extinguishers, one located in the dining room and one in the garage, were last serviced on 4/29/26.
The first aid kit was reviewed and contained a tweezer, scissors, thermometer, salves, band aids and gauze. A first aid manual was also observed.
Cleaning solutions and disinfectants are stored in a locked cabinet under the kitchen sink and in the locked garage. Sharp knives are stored in a locked kitchen drawer

Continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

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: EMVY BOARD AND CARE FACILITY	FACILITY NUMBER: 197608459
	VISIT DATE: 08/19/2026

NARRATIVE

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The facility telephone number was verified and is current as noted in the facility profile.
Current general liability insurance expires on 8/19/26. Evidence of continuing coverage was requested from the broker and provided for policy term 8/19/26 - 8/19/27 during the visit. The policy limits meet Title 22 requirements - $1 million per occurrence and $3 million per annual aggregate.
The garage houses the washer and dryer and is primarily used for storage
A cover patio furnished with a table, seating for 6 and a swing chair was observed in the backyard.
a second ramp was also noted from the backdoor exit.
The 2 side gates were observed to be unlocked from the inside.
Overall, the inside and outside of the facility, were observed to be clean.

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Immediate Civil Penalties of $500 were assessed.

Exit interview was conducted, APPEALS RIGHTS were assessed and a copy was provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/19/2026 06:25 PM - It Cannot Be Edited

Created By: Christine Yee On 08/19/2026 at 05:36 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: EMVY BOARD AND CARE FACILITY	FACILITY NUMBER: 197608459
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87203

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. 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 it was observed during the testing of the hardwired smoke detectors, that the magnates that hold the 2 fire rated doors mounted on the entrance to the resident hallway and on bedroom #3, did not activate to release the doors to secure the resident rooms when the smoke detectors were tested which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/20/2026
	Plan of Correction
1 2 3 4	The Licensee will have the magnates used to hold the 2 fire rate doors open iand the hardwired smoke detector system nspected to determine what is causing the magnates to fail to activate and fix the problem. The Licensee will provide evidence of the correction or self certify that the problem with the magnates have been corrected by 8/20/26

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.

	Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:

	Christine Yee
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

LIC809 (FAS) - (06/04)

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