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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608986
Report Date: 01/24/2025
Date Signed: 01/24/2025 11:55:15 AM

Document Has Been Signed on 01/24/2025 11:55 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. #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:
01/24/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:53 AM
MET WITH:Lala Soghomonyan - AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Brian Balisi and Trevor Byrne conducted an unannounced Case Management - Deficiencies visit. LPA's were joined by LA fire inspector Benjamin Guzman. Reason for this report is to issue deficiency observed during the pre-licensing visit for Age Well Assisted Living #195850516. During today’s visit, LPAs met with Administrator Lala Soghomonyan and explained the reason for the visit. Licensee Sarkis Dovlatyan arrived shortly after.

The following was observed:
At approx 10:00a.m, the structure in the rear of the facility was observed to be occupied by the family of Licensee Sarkis Dovlatyan. Inspector Guzman informed Sarkis the structure is not licensed as an Adult Dwelling Unit (ADU) and should not be occupied at this time. Sarkis was advised by Guzman to begin application process with Los Angeles Department of Building Services (LADBS) and for it to be completed by June 1st, 2025.

At approx 10:10 a.m. it was observed that the entire property is not completely fenced as there was access to the adjacent structures located on the property.

A $500 immediate civil penalty is assessed today for violation of fire clearance. The Administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f).

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights explained and report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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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Document Has Been Signed on 01/24/2025 11:55 AM - It Cannot Be Edited


Created By: Brian Balisi On 01/24/2025 at 11:20 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: AGE WELL ASSISTED LIVING FACILITY
FACILITY NUMBER: 197608986

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2025
Section Cited
CCR
87202(a)

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All facilities shall maintain a fire clearance approved by the city... or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by:
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Licensee agreed to ensure structure is unoccupied and follow instructions provided by LA Fire inspector as well as provide a written plan to LPA via email by COB 01/27/2025.
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Based on physical plant, the licensee did not comply with the section cited above as tenants were occupying an illegal conversion of an ADU, which poses an immediate health, safety and personal rights risk to residents to care.
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Type B
02/07/2025
Section Cited
CCR87307(d)(2)

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The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.This requirement was not met as evidence by:
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Licensee agreed to fence the adjacent structures making them inaccessble to the facility and provide proof of installation via email to LPA by COB 02/07/2025.
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Based on physical plant the licensee did not comply with the section cited above as residents in care had access to adjacent structures located on the property, which poses a 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.
SUPERVISOR'S NAME:Desaree Perera
LICENSING EVALUATOR NAME:Brian Balisi
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2025


LIC809 (FAS) - (06/04)
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