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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609815
Report Date: 07/25/2025
Date Signed: 07/25/2025 03:12:18 PM

Document Has Been Signed on 07/25/2025 03:12 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 S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:LAND OF PEACE 4FACILITY NUMBER:
197609815
ADMINISTRATOR/
DIRECTOR:		SONA MURADYANFACILITY TYPE:
740
ADDRESS:22615 KITTRIDGE STREETTELEPHONE:
(818) 704-4204
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 6CENSUS: 6DATE:
07/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:44 AM
MET WITH:Sona MuradyanTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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At 11:45 a.m. on 07/25/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with the administrator and disclosed the reason for the visit.

The facility was last visited on 07/26/24 for an annual visit. It is a single story building with six (06) bedrooms, three (03) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) residents, of which five (05) may be non-ambulatory and one (01) bedridden in Bedroom #6. The facility serves residents with dementia. Approved hospice waivers for six (06).

The front yard was maintained. At the main entrance, LPA observed postings for the activity calendar, resident rights, rights of resident councils, Ombudsman contact, confidential complaints, emergency disaster plan, house rules, neighborhood grievance policy, non-discrimination notice, visitation policy, administrator certificates, COVID precautions, facility sketch, and the facility license. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. A fireplace was appropriately covered. The hallway closet contained an adequate supply of fresh linens and towels. At 12:00 p.m. LPA measured the room temperature to be 76 degrees Fahrenheit. The house telephone was called at 12:15 p.m. and determined functional. Reading materials, puzzles, television, a piano, and art supplies were observed in the living room.

LPA observed an adequate supply of perishable and non-perishable food in the kitchen and garage refrigerators and freezers. LPA also observed food preparation and plating for lunch. The stove hood was clean. Medications were locked by the refrigerator. Sharp objects were locked under the counter top. A washer and dryer in good condition were located near the kitchen. Detergents and cleaners were locked above the appliances. At 12:30 p.m. LPA observed a fully charged fire extinguisher near the laundry area.

Naira MargaryanTELEPHONE: (818) 596-4368
Nicholas ReedTELEPHONE: (818) 669-8178
DATE: 07/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2025
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 S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LAND OF PEACE 4
FACILITY NUMBER: 197609815
VISIT DATE: 07/25/2025
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Staff and LPA conducted a medication review at approximately 12:35 p.m. for three (03) residents. All medications were maintained in the proper quantities.

The facility has six (06) bedrooms. One (01) bedroom is designated for staff. The staff bedroom was locked and free of hazards. All bedrooms contained a night stand, lamp, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Facility sketches with emergency evacuation routes labelled were posted in each room.

The facility has three (03) bathrooms. All resident bathrooms contained liquid soap, paper towels, trash cans, grab bars near the toilet, shower, and commode, and a non-skid mat in the shower. At 12:55 p.m. LPA measured the water temperature in the shared bathroom near Bedroom #2 to be 119.1 degrees Fahrenheit.

Two (02) out of two (02) emergency exit paths were free from obstructions. The exit gate was unlocked. Ramps with secure hand rails led out from Bedroom #5 and a sliding glass door near the living room. At 1:15 p.m. the administrator tested the smoke and carbon monoxide detector to be operational. The covered patio area contained furniture was in good condition. The back yard was maintained and contained a gardened area, a grill, and exercise equipment. The garage was locked and contained extra supplies.

At 1:30 p.m. LPA reviewed resident and personnel files. All files were complete and available for audit.

During today's inspection, the facility is in compliance with Title 22 regulations. No immediate health and safety risks were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025
LIC809 (FAS) - (06/04)
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