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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608986
Report Date: 10/07/2025
Date Signed: 10/07/2025 05:11:06 PM

Document Has Been Signed on 10/07/2025 05:11 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:AGE WELL ASSISTED LIVING FACILITYFACILITY NUMBER:
197608986
ADMINISTRATOR/
DIRECTOR:		LALA SOGHOMONYANFACILITY TYPE:
740
ADDRESS:15149 SYLVAN STREETTELEPHONE:
(818) 666-1665
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY: 6CENSUS: 5DATE:
10/07/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:58 AM
MET WITH:Lala SoghomonyanTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Sandra Urena and Trevor Byrne conducted an unannounced case management - deficiencies visit. LPAs arrived to the facility at 10:58 AM. LPAs met with the facility staff #1 (S1) who contacted the facility Administrator Lala Soghomonyan via telephone call. The Administrator arrived to the facility at 11:49 AM and the licensee representative arrived at 02:06 PM. Entrance interview was conducted and the reason for the visit was explained.

During today’s visit, the LPAs conducted a physical plant tour to ensure there are no health and safety hazards, conducted a file review for three (3) residents, one (1) staff, and conducted interviews with the Administrator, one (1) staff member, five (5) residents, and the licensee representative between 11:00 AM and 04:00 PM.

During record review LPAs observed one (1) staff file to be missing documents including but not limited to: 1st aid certification, required trainings, and documentation of fingerprint clearance/exemption.

Continued on LIC 809C.
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2025
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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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: AGE WELL ASSISTED LIVING FACILITY
FACILITY NUMBER: 197608986
VISIT DATE: 10/07/2025
NARRATIVE
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Upon arriving to the facility LPAs were greeted by S1 who allowed LPAs entry to the facility. After gaining entry to the facility S1 left the facility and was unable to be located by LPAs. LPAs did not observe another staff member present at the facility until the Administrator arrived at 11:49 AM. LPAs informed the Administrator that absence of supervision is a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (10/07/2025). LPA informed Administrator that failure to ensure adequate staff supervision may result in the assessment of additional civil penalties. Interviews with the licensee representative and residents confirmed the presence of Staff #2 (S2) at the facility earlier in the day. LPAs reviewed the list of individuals associated to the facility and did not observe S2 on this list. LPAs interviewed the Administrator who confirmed that S2 has started the process of obtaining Department of Justice (DOJ) fingerprint clearance, but they have not yet obtained clearance for S2 from DOJ. LPAs informed the Administrator that the presence of an employee at the facility without a valid criminal record clearance or exemption would result in a civil penalty. LPAs observed that the facility was cited on 09/10/2025 for the presence of S2 at the facility without a valid criminal record clearance. LPAs observed that S2 had been employed by the facility since approximately 09/05/2025. LPAs informed the Administrator that an immediate civil penalty in the amount of $3,000 will be assessed on today’s date (10/07/2025) for the presence of S2 at the facility. LPAs informed Administrator that failure to obtain proper clearance for S2 may result in the assessment of additional civil penalties.

During the physical plant tour LPAs observed an unlocked drawer in the kitchen that contained knives and other sharp objects accessible to clients in care. The Administrator secured the drawer at the time of the visit.

During today’s visit LPAs had a conversation with the licensee representative and Administrator requesting that they be more responsive to CCLD when contacted to avoid delays in communication and for the safety and wellbeing of clients in care. The licensee representative and Administrator expressed understanding and agreed to be more responsive when contacted by CCLD.


Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies and civil penalties 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: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 10/07/2025 05:11 PM - It Cannot Be Edited


Created By: Trevor Byrne On 10/07/2025 at 04:01 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: AGE WELL ASSISTED LIVING FACILITY
FACILITY NUMBER: 197608986

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/08/2025
Section Cited
CCR
87468.2(a)(4)

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87468.2(a)In addition to the rights listed in Section 87468.1 (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by:
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Licensee will submit a plan how they will ensure appropriate resident care and supervision will be provided at all times no later than POC due date.
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Based on interviews and observation the licensee did not comply with the section cited above as qualified staff were not present during the initial inspection of the facility; Administrator arrived about an hour after the LPAs arrived at the facility, which posed an immediate health and safety risks to residents in care.
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Type A
10/08/2025
Section Cited
CCR87309(a)

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87309 (a) Storage Space and Access (a) ...the licensee shall ensure that.. knives,...sharp objects,...are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by:
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Administrator locked the cabinet during the visit. POC cleared.
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Based on observation, the licensee did not follow this regulation when they left knives and other sharp objects accessible to residents in care by not locking the kitchen drawer, which poses an immediate Health and Safety risk to persons 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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Trevor Byrne
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/07/2025 05:11 PM - It Cannot Be Edited


Created By: Trevor Byrne On 10/07/2025 at 04:06 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: AGE WELL ASSISTED LIVING FACILITY
FACILITY NUMBER: 197608986

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/08/2025
Section Cited
CCR
87355(e)(1)

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Criminal Record Clearance: (e) All individuals subject to a criminal record review ...(b) shall prior to working... in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department…This requirement is not met as evidenced by:
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Licensee agrees to obtain criminal background fingerprint clearance for S2, and S2 will not work until criminal background clearance has cleared.
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Based on observation and record review, the licensee did not comply with the section cited above as a criminal background fingerprint clearance was not conducted for S2, which poses an immediate health and safety risk to persons in care.
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Type A
10/08/2025
Section Cited
CCR87412(a)(c)

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The licensee shall ensure that personnel records are maintained on… each employee. Each personnel record shall contain the following information: (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by:
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Licensee agreed to submit a completed personnel file for S1 to CCLD no later than POC due date.
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Based on record review, one (1) out of one (1) personnel record reviewed, did not have proof of CPR/First Aid Training, or required annual training, which poses an immediate health and safety risk to persons 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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Trevor Byrne
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2025


LIC809 (FAS) - (06/04)
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