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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609604
Report Date: 02/28/2025
Date Signed: 02/28/2025 05:15:32 PM

Document Has Been Signed on 02/28/2025 05:15 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: 6DATE:
02/28/2025
TYPE OF VISIT:Case Management - DeficienciesANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Mariam Baghdoyan, StaffTIME VISIT/
INSPECTION COMPLETED:
05:25 PM
NARRATIVE
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Licensing Program Analyst(LPA) conducted an unannounced case management visit to the deficiencies noted during a visit to the facility today and on many visits. LPA Yee conducted the visit with Mariam Baghdoyan, Staff as Asmik Nadrian, Licensee does not participate in the operations of the facility and Elena Kordonskiy, Administrator works part time and is at the facility mostly in the evenings and on today's visit is currently out of town. The reason for today's visit was provided.

The following deficiencies were again observed on today's visit and the previous visit's conducted:
  • The facility was not able to locate files for previous residents in care on visits conducted today-2/28/25 and the following dates 12/11/24, 2/12/25, 2/24/25. Per the staff, they are just employees and it is not their responsibility to maintain files.
  • Elena Kordonskiy, Administrator, is not present at the facility for a sufficient number of hours to oversee the operations of the facility during business hours and maintain resident and staff records as evidenced by the number of complaints received and the many deficiencies that the facility is being cited for as of today.
  • Copies of training logs and resident records were requested from the Administrator for review during the visit and never provided to LPA. Administrator was on her cell phone the entire visit today.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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 3
Document Has Been Signed on 02/28/2025 05:15 PM - It Cannot Be Edited


Created By: Christine Yee On 02/28/2025 at 04:07 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: 02/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2025
Section Cited
CCR
87506(d)

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Resident Records:87506(d)All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements:
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Licensee will review all resident files for completeness and deliver copies of all 6 resident files and all staff monthly training and annual inservice records to the Department for review by 3/7/25.
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All Resident records and Staff training records were requested for review and was never provided by the Administrator as she was on her cellphone the entire visit.
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***copies of training logs were provided at the end of the visit*** pending are complete copies of all 6 resident files.
Type B
03/07/2025
Section Cited
CCR87506(e)

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Resident Records:Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident.
This requirement was not met as evidenced by: Request for former Resident #1 files and other former residents are not provided
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Licensee will ensure that all current and former resident's files are maintained for 3 yeas and made available to the Department for review. Provide the Department with a copy of Resident #1's file by 3/7/25.
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when requested. Per staff and Administrator, they cannot locate the files
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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:Kristin Heffernan
LICENSING EVALUATOR NAME:Christine Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/28/2025 05:15 PM - It Cannot Be Edited


Created By: Christine Yee On 02/28/2025 at 04:31 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: 02/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2025
Section Cited
CCR
87405(a)

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Administrator - Qualifications and Duties: All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient
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The Administrator will read Title 22, Section 87405 completely and submit a written statement that the section was read and understood. Administrator will also provide an updated LIC500 indicating her hours that she is at at the facility to administer her duties of an Administrator. Administrator will also be
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number of hours to permit adequate attention to the management and administration of the facility as specified in this section.
Elena Kordonskiy, Administrator is not at the facility for sufficient number hours to administer the duties of an Administrator and the facility is being constantly cited
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available during business hours to conduct visits with the Department. Please provide the plan of correction by 3/7/25.

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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:Kristin Heffernan
LICENSING EVALUATOR NAME:Christine Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2025


LIC809 (FAS) - (06/04)
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