<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608986
Report Date: 01/05/2026
Date Signed: 01/05/2026 02:02:03 PM

Document Has Been Signed on 01/05/2026 02:02 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:AGE WELL ASSISTED LIVING FACILITYFACILITY NUMBER:
197608986
ADMINISTRATOR/
DIRECTOR:		NAILAH TATUMFACILITY TYPE:
740
ADDRESS:15149 SYLVAN STREETTELEPHONE:
(818) 666-1665
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY: 6CENSUS: 2DATE:
01/05/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Acting Administrator Arshalouis ManoukianTIME VISIT/
INSPECTION COMPLETED:
02:30 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 Analysts (LPAs) Brian Balisi  conducted a Case Management - Other visit to the facility.  The purpose of the visit is to hand deliver a Decision and Order to Licensee facility Sarkis Dovlatyan.  LPA arrived at the facility at approx 11:00 a.m. Upon arrival LPA's met with staff and explained the reason for the visit.  LPA attempted to contact Licensee Sarkis Dovlatyan, but was unsuccessful. Licensee messaged LPA stating that they are out of town, but will have their Acting Administrator Arshalouis Manoukian meet LPA. LPA responded to Licensee's message requesting to speak over the phone.

LPA, alongside Acting Administrator  Arshalouis Manoukian reviewed and discussed the contents of the Decision and Order CDSS NO. 6124053301B and CDSS NO 6124053301C;  served on 01/02/2026 for the Decertification / Non-Immediate Exclusion of Respondent Sarkis Dovlatyan.

LPA and Acting Administrator Arshalouis Manoukian also reviewed and discussed the contents of CDSS No. 6124053301 OAH No. served on 12/31/2025,  for  Revocation for the Facility license of Age Well Assisted Living Inc Facility # 197608986

LPA reminded Manoukian that documents need to be shared with residents, residents responsible persons, and is required to be posted in the facility in a prominent place.  LPA shared and discussed the Health and Safety Code §1569.38 Posting of licensing reports; disclosure to new residents with Manoukian.  Manoukian acknowledged understanding of the requirement.
During today's visit LPA conducted physical plant, interviewed staff and residents. The following was observed:
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Brian Balisi
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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)
Page: 2 of 5
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AGE WELL ASSISTED LIVING FACILITY
FACILITY NUMBER: 197608986
VISIT DATE: 01/05/2026
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
26
27
28
29
30
31
32
At approx 11:37 a.m. LPA observed Resident #1 (R1) access their own medications from the locked medication cabinet. R1 then administered their own medication without assistance from Staff #1 (S1).

At approximately 11:40 a.m., LPA observed R1 and S1 engaged in a verbal interaction during which both individuals were speaking loudly to one another. LPA instructed R1 and S1 to separate and calm down. An interview with R1 indicated that S1 constantly speaks to R1 in an aggressive tone. An interview with S1 indicated that S1 believed they were responding defensively due to R1 speaking to them in an unpleasant manner.

LPA's interview  with R1 and Resident #2 (R2), revealed both stated that on the evening of 01/03/2025, they were informed by an individual that R1 and R2 would need to relocate from the facility by Monday morning. R1 and R2 further stated they were not provided with a written or official notice to vacate the facility. Interview with Manoukian revealed that a representative from a tentative new facility arrived to the home and informed  Manoukian they were there. Manoukian arrived approx 15 mins later and the representative was gone.   A review of records by LPA found no eviction notice had been provided to the Department.

During today’s visit, the LPAs conducted a tour of the facility inside and outside to ensure there were no immediate health or safety hazards. All utilities were observed to be on and functioning properly. The LPAs observed the kitchen and food supply and there is a sufficient amount of both perishable and non-perishable foods.

The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). Civil penalties in the amount of $500 will be assess today for repeat violations. The Licensee rep was informed that failure to correct the deficiencies may result in additional civil penalties.


At 11:45 a.m, 12:57 p.m. and 01:48 LPA attempted to contact Licensee Sarkis Dovlatyan by phone and text message, but was unsuccessful.

Exit interview conducted with Manoukian, appeal rights discussed, and a copy of this report was provided. Manoukian was informed that they are cannot accept any new residents.
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Brian Balisi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026
LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 01/05/2026 02:02 PM - It Cannot Be Edited


Created By: Brian Balisi On 01/05/2026 at 01:14 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: 01/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/06/2026
Section Cited
CCR
87465(h)(2)

1
2
3
4
5
6
7
Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee representative spoke with R1 regarding their access to medication. Licensee also agreed to review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 01/06/2026.
8
9
10
11
12
13
14
Based on interviews and observations the Licensee did not comply with the regulation cited above as the R1 was observed accessing the centrally stored medication cabinet , which posed an immediate health, safety and personal rights risks to persons in care.
8
9
10
11
12
13
14
Type A
01/06/2026
Section Cited
CCR87468.1(a)(1)

1
2
3
4
5
6
7
To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee representative spoke with R1 and S1 during the visit. Licensee rep also agreed to review review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 01/06/2026.
8
9
10
11
12
13
14
Based on interviews and observations the Licensee did not comply with the regulation cited above as S1 and R1 were involved in a verbal altercation which posed an immediate health, safety and personal rights risks to persons in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Brian Balisi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2026


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/05/2026 02:02 PM - It Cannot Be Edited


Created By: Brian Balisi On 01/05/2026 at 01:17 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: 01/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/12/2026
Section Cited
CCR
87224(a)

1
2
3
4
5
6
7
The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee agreed to review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 01/12/2026.
8
9
10
11
12
13
14
Based on interviews and records review the Licensee did not comply with the regulation cited above as R1 and R2 were told to vacate the facility by 01/05/2026, which posed an potential health, safety and personal rights risks to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Brian Balisi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5