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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608595
Report Date: 06/18/2025
Date Signed: 06/18/2025 11:56:35 AM

Document Has Been Signed on 06/18/2025 11:56 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:NEST, THEFACILITY NUMBER:
197608595
ADMINISTRATOR/
DIRECTOR:		MICHELLE WEISMANFACILITY TYPE:
740
ADDRESS:4100 HAYVENHURST AVENUETELEPHONE:
(818) 990-6896
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY: 6CENSUS: 6DATE:
06/18/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Michelle Wieisman, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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This Informal Conference was held at the Woodland Hills South Regional Office to discuss issues and concerns involving the Licensee/Administrator.

Attendees present at the meeting are:

Licensee/Administrator, Michelle Weisman
Staff, Janeth Alfaro
Licensing Program Manager, Naira Margaryan
Licensing Program Manager, Nichelle Gillyard
Licensing Program Analyst Angela, Panushkina
Licensing Program Analyst, Huma Rahimi

LPMs Naira Margaryan and Nichele Gillyard informed Mrs. Weisman that the purpose of the informal meeting was to discuss a complaint (control # 31-AS-20240923114331) received by the Regional Office on 09-23-2024, alleging Unlicensed Care to 4 individual who at one point lived at 5712 Tampa Ave. Tarzana 91356.

On 10-03-2024, LPAs Panushkina and Rahimi initiated the complaint investigation. While touring the home, LPAs interviewed the Unlicensed Operator, Michelle Weisman, one (1) staff and attempted to interview two (2) residents present. LPAs left and conducted collateral visit to visit to The Nest facility # 197608595 to interview two (2) residents and staff previously observed at the Unlicensed location. LPAs also obtained copies of pertinent documents relevant to the complaint investigation. Continue on LIC9099-C
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Angela Panushkina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2025
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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Document Has Been Signed on 06/18/2025 11:56 AM - It Cannot Be Edited


Created By: Angela Panushkina On 06/18/2025 at 09:02 AM
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: NEST, THE
FACILITY NUMBER: 197608595

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/25/2025
Section Cited
CCR
87405(d)(2)

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Administrator - Qualifications and Duties:
(d) The administrator shall have the qualifications specified in Sections 87405… If the licensee is also the administrator, all requirements..(2)Know- ledge... to the applicable laws, rules...
This requirement is not met as evidenced by
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Administrator will provide a written statement informing the department that moving forward she will follow all applicable laws and regulations govening ARFs and RCFEs.

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The Administrator, who also is a licensee, failed to comply to the section 87405.
This posses potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Angela Panushkina
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2025


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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: NEST, THE
FACILITY NUMBER: 197608595
VISIT DATE: 06/18/2025
NARRATIVE
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Based on the information gathered it was determined that four (4) residents were being provided elements of care and supervision which include significant assistance with ADLs (i.e. dressing, bathing, toileting, incontinent care) and assistance with medications management. During the investigation of an Unlicensed complaint it was discovered that the Operator is the Administrator/Licensee of The Nest - a licensed facility (#197608595). Base on overall investigation, the complaint deemed to be Substantiated. A copy of the report, deficiency, and Notice of Violation of the Law (NOVL) will be issued at conclusion of this meeting.

LPM Margaryan discussed the complaint and that moving forward no operation of an Unlicensed home is allowed while running a licensed facility. Any violation of Title 22 Regulation may result other adverse actions as it deemed necessary by the Department.

Mrs. Weisman stated the following: I only had my family members that I took care of. Currently, there are no residents living at Unlicensed location.

LPM Margaryan informed Mrs. Weisman a Certified RCFE (Residential Care facility for the Elderly) Administrator with CCL (Community Care Licensing) that she must immediately discontinue the unlicensed operation. Continuation of Unlicensed operation may impact Ms. Weisman’s Administrators certificate.
During this meeting, Administrator Qualifications and Duties were discussed and the Licensee/Administrator was informed that at this time Ms. Weisman is in noncompliance with Title 22 Regulations Section 87405- Administrator Qualifications and Duties Therefore, at the time of this meeting the citation was issued under Title 22 Regulation, Division 6 Chapter 8.

Exit interview conducted and copy of this report
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Angela Panushkina
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC809 (FAS) - (06/04)
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