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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609604
Report Date: 07/31/2025
Date Signed: 07/31/2025 04:43:38 PM

Document Has Been Signed on 07/31/2025 04:43 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:HM SWEET HOMEFACILITY NUMBER:
197609604
ADMINISTRATOR/
DIRECTOR:		NADRIAN, ASMIKFACILITY TYPE:
740
ADDRESS:6215 BLUEBELL AVENUETELEPHONE:
(818) 903-6302
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 6CENSUS: 5DATE:
07/31/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:08 AM
MET WITH:Arshalouis Manoukyan - AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Quoc Huynh conducted a Case Management visit in conjunction with Complaint # 29-AS-20250211151153. LPA arrived at 9:08AM and met with Administrator Arshalouis Manoukyan, who arrived at 10:04AM, and explained the reason for the visit. Entrance interview conducted.

At 10:31AM, the LPA and Administrator toured the physical plant areas to ensure there were no health and safety hazards. No immediate concerns were observed.

During the Department’s investigation of complaint # 29-AS-20250211151153, the following deficiencies were observed:

The Department’s investigation revealed the facility is operating under a different name “7 Heaven”. It was discovered that administrator Elena Kordonskiy requested that Resident #1’s (R1) resident representative pay a fee of $2,000 as a payment for 7 Heaven facility, and an admission fee of $500 to Kordonskiy. Kordonskiy admitted that she did collect the money for the 7 Heaven facility under the direction of the owner. As of 07/31/2025, the facility did not issue R1’s representative an admission refund as R1 resided at the facility between 01/01/2025 to 01/13/2025. R1’s signed admission agreement stated “HM Sweet Home charges a nonrefundable pre-admission fee in the amount of $500. The fee is non-refundable unless any of the following arises: If the client stays in the facility for one month only, then 80% of the rate will be refunded …” Therefore, the facility did not operate within their plan of operation. Additionally, during LPA Huynh’s annual visit on 07/31/2025, the LPA observed the Administrator Arshalouis forge a resident’s initials on their admission agreement.

Report Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2025
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: HM SWEET HOME
FACILITY NUMBER: 197609604
VISIT DATE: 07/31/2025
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The administrator and caregivers acknowledged that R1 required a different facility to receive a higher level of care and did not adhere to their own Admission Agreement policy which states: “Basic Services: b. Thorough supervision and care. c. Immediate notification to family, physician, and any other relevant agency of the resident’s changing needs. Termination of Agreement: The facility is responsible for creating a relocation evaluation and a closure plan in case of eviction. The relocation evaluation will be based on the residents' needs and the services being provided for them. If we are unable to meet their needs, the resident must be relocated. In the event of eviction, the facility will prepare a closure plan outlining the resident's needs, the reason for eviction, and the services that need to be provided to the resident.” R1’s need for a higher level of care was not reported to R1’s resident representative or physician.

The administrator and caregivers acknowledged seeing and attempting to treat R1’s wounds but did not report them to R1’s resident representative or R1’s physician.

There was no incident report submitted for R1’s 01/11/2025 Sherman Oaks hospital visit. On 01/22/2025, the administrator emailed an incident report to the Department for R1’s Kaiser hospital visit. The incident date was listed as 01/15/2025, however, the correct date R1 was sent to Kaiser hospital was 01/13/2025. In addition, the information in the incident report is not accurate. During the Department’s complaint investigation R1’s resident representative stated they did not want R1 to have a catheter and preferred a less invasive option. However, the incident report written by the administrator states “R1 had a UTI and was sent to Kaiser to consult with the urologist about having a catheter. R1’s resident representative was suggesting R1 to have it so not to be wet so often because the urine was leaking non-stop”.

Pursuant to Title 22 California Code of Regulations and/or Health and Safety Code, the following deficiencies are cited (refer to LIC 809-D).

The Administrator was unavailable and the LPA reviewed the report via telephone call . The Administrator designated Staff Mariam Baghdayan to sign the report. Exit interview conducted. A copy of the Appeal Rights and report were reviewed and provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 07/31/2025 04:43 PM - It Cannot Be Edited


Created By: Quoc Huynh On 07/31/2025 at 03:13 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: HM SWEET HOME
FACILITY NUMBER: 197609604

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2025
Section Cited
CCR
87207

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No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.

This requirement is not met as evidenced by:
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The Licensee will submit a statement of understanding and review the resident's admission agreement with their representative. The Licensee will send CCLD proof by POC due date.
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Based on records review and interviews, the licensee did not comply with the section cited above. The facility is operating under a different name “7 Heaven” and forged a resident’s initials on their admission agreement, which posed an immediate health and safety risk to residents in care.
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Type A
08/01/2025
Section Cited
CCR87507(f)

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(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments.

This requirement is not met as evidenced by:
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The Licensee will submit a statement of understanding and will train staff on evaluating residents before their admission acceptance. The Licensee will send CCLD proof by POC due date.
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Based on interviews, the licensee did not comply with the section cited above. The facility retained R1 who needed a higher level, which posed an immediate 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.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/31/2025 04:43 PM - It Cannot Be Edited


Created By: Quoc Huynh On 07/31/2025 at 03:15 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: HM SWEET HOME
FACILITY NUMBER: 197609604

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2025
Section Cited
CCR
87466

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The licensee shall ensure that residents are regularly observed for changes … and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as … a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by:
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The Licensee will submit a statement of understanding and train staff on reporting resident observations and send CCLD proof by POC due date.
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Based on interviews, the licensee did not comply with the section cited above. The administrator and caregivers acknowledged seeing and attempting to treat R1’s wounds but did not report them to R1’s resident representative or R1’s physician, which posed an immediate health and safety risk to residents in care.
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Type B
08/04/2025
Section Cited
CCR87211(a)(1)(B)

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(a) Each licensee shall furnish to the licensing agency … (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of … (A) through (D) ... This report shall include the resident's name …; date and nature of event; …, findings, and treatment, if any; and disposition of the case. (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by:
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The Licensee will review reporting requirements, ensure copies of reports are maintained, and submit a statement of understanding to CCLD by POC due date.
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Based on record review, the licensee did not comply with the section cited above. No incident reports submitted for R1’s 01/11/2025 and 01/13/2025 hospital visits. The report submitted states a 01/15/2025 incident and does not contain accurate information, which posed 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.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/31/2025 04:43 PM - It Cannot Be Edited


Created By: Quoc Huynh On 07/31/2025 at 03:22 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: HM SWEET HOME
FACILITY NUMBER: 197609604

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2025
Section Cited
CCR
87208(a)

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(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. …

This requirement was not met as evidenced by:
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The Licensee will issue the resident's representative their admission refund according to their refund policy and send CCLD proof by POC due date.
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Based on interview and record review, the licensee did not comply with the section cited above as the licensee did not comply with their refund policy stated in the admission agreement, which posed/poses an immediate health, safety, and personal rights 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.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2025


LIC809 (FAS) - (06/04)
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