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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609656
Report Date: 03/25/2025
Date Signed: 03/31/2025 03:27:54 PM

Document Has Been Signed on 03/31/2025 03:27 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:VAN NOORD MANORFACILITY NUMBER:
197609656
ADMINISTRATOR/
DIRECTOR:		MKRTCHIAN, VAHEFACILITY TYPE:
740
ADDRESS:6700 VAN NOORD AVETELEPHONE:
(818) 414-0005
CITY:VALLEY GLENSTATE: CAZIP CODE:
91606
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
03/25/2025
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Vahe Mkrtchian, AdministratorTIME VISIT/
INSPECTION COMPLETED:
07:35 PM
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was let into the home by Christian Senoren , staff. Vahe Mkrtchian, Administrator was contacted by staff and he arrived a little later to conduct the visit. Romulus Mabalot, Designated Responsible Staff, also assisted with the visit. The reason for today's visit was provided.

The facility is a single storey family home consisting of a living room, dining room, kitchen, four bedrooms of which one is used for live-in staff, 2 full common bathrooms and a attached garage. Located in the backyard is a swimming pool fenced in by a 5 foot rod iron fence. The facility is fire cleared for 3 NON-AMBULATORY AND 1 BEDRIDDEN resident. Bedroom #1 is currently designated for bedridden use. The facility is vendorized by the North Los Angeles County Regional Center as a Level 3 home.

All 12 domains of the CARE Inspection Tool were reviewed on today's visit. All 4 resident and 4 staff files were also reviewed.

The following were observed:
  • Bedroom #1, is a shared room, located in the front right side of the hallway, contained 2 each of the following - beds, night stands, chairs, lamps, dressers and a shared closet. Sufficient lighting was observed. Bedroom #1 is currently designated as the bedridden room. Auditory device mounted on the door was operational.V
Kristin HeffernanTELEPHONE: (818) 596-4493
Christine YeeTELEPHONE: (747) 230-3890
DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2025
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: VAN NOORD MANOR
FACILITY NUMBER: 197609656
VISIT DATE: 03/25/2025
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  • bedroom #2, located towards the back left side of the hallway was observed with a single twin bed, 2 chairs, 1 night stand, 1 lamp and 1 dresser and a closet. The auditory device on the door was tested and was operational.
  • Bedroom #3, located towards the back right side of the hallway was observed with a single twin bed, 2 chairs, 1 lamp, 1 night stand, a dresser, 2 chairs and a closet. The auditory device on the door was tested and was operational.
  • The locked hallway closet located at the end of the hallway is used to store the medications, hygiene products, paper products, first aid kit and first aid manual.
  • The 2 common bathrooms, located by the bedrooms were both equipped with a walk-in shower, grab bars, slip resistant mats, shower chairs, a toilet and a single sink. Water temperature tested in the bathroom located on the left side of the hallway read 119.5 degrees Fahrenheit and the bathroom on the right side read 112.7 degrees Fahrenheit
  • Bedroom #4, front left, is designated for live-in staff. Room was toured and contained 2 beds and other furniture.
  • The kitchen is equipped with a refrigerator, dish washer, microwave, stove and air fryer. Sufficient perishable for a minimum of 2 days and non-perishable for a minimum of 7 days were observed. Cleaning products and disinfectants are stored in a locked cupboard under the kitchen sink. Knives are stored in a locked kitchen drawer.
  • The only fire extinguisher purchased on 1/30/25 is located in the kitchen by the refrigerator.
  • The hardwired smoke detectors located inside resident and staff rooms and the 2 combination smoke/carbon monoxide detectors in the hallway were tested and were operational.
  • Staff first aid and CPR training expire 3/2025. Training is scheduled for all 4 staff on 3/28/25
  • Staff and Residents files all have the required documents.
  • Staff have criminal record clearances and are associated to the facility
  • A washer and dryer was observed on the covered back patio. Also located on the back patio are 2 wicker chairs. Trash cans were observed with tightly sealed covers.
  • Located in the back is a swimming pool surrounded by a 5 feet rod iron fence.
  • A wicker love seat, 2 wicker arm chairs and a little table were observed on the covered front patio.
  • Overall the facility, inside and outside, were observed to be clean and well maintained

No deficiencies were cited on today's visit. Exit interview was conducted.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
LIC809 (FAS) - (06/04)
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