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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609819
Report Date: 07/27/2026
Date Signed: 07/27/2026 02:42:10 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/27/2026 02:42 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:NANA'S DREAM HOUSE FACILITYFACILITY NUMBER:
197609819
ADMINISTRATOR/
DIRECTOR:		BADALYAN, NAIRAFACILITY TYPE:
740
ADDRESS:7333 IRVINE AVETELEPHONE:
(818) 392-0843
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 6CENSUS: 5DATE:
07/27/2026
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:16 AM
MET WITH:Naira BadalyanTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a continuation of the required annual visit at 10:16 AM. LPA met with the facility Administrator Naira Badalyan. Entrance interview was conducted and the reason for the visit was explained.

RECORD REVIEW: Record review began at 10:22 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) resident files were reviewed. Two (2) resident admission agreements were observed to be missing the rate for basic services. Three (3) resident files for residents who were identified as having hearing loss were missing the required Telecommunications Device Notification form (LIC 9158). Two (2) incident reports were observed in resident files. LPA reviewed the facility’s file and did not observe incident reports for these incidents. LPA observed that the incident reports were sent within the required timeframe but were submitted to the incorrect fax number. This is considered a technical violation and no deficiency is being generated under this report. LPA provided the appropriate fax number to the Administrator who agreed to submit all future incident reports to the appropriate fax number. Five (5) staff files were reviewed. All staff files reviewed contained the required documentation and trainings.

MEDICATION REVIEW: Medication review began at 12:05 PM. Medications are stored centrally and securely in the Administrator’s office. Medications for three (3) residents were observed. All medications reviewed were properly stored and were properly documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. CONTINUED ON LIC 809C.

Kasandra Lopez
Trevor Byrne
DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2026
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 07/27/2026 02:42 PM - It Cannot Be Edited


Created By: Trevor Byrne On 07/27/2026 at 02:08 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: NANA'S DREAM HOUSE FACILITY
FACILITY NUMBER: 197609819

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2026
Section Cited
CCR
87507(g)(3)(A)

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87507 Admission Agreements
(g) Admission agreements shall specify the following:
(3) Payment provisions, including the following:
(A) Rate for all basic services...
This requirement is not met as evidenced by:
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Administrator agreed to update the admission agreements for the identified residents and to obtain signatures from the residents responsible parties. Administrator agreed to submit the updated admission agreements to CCLD no later than POC due date.
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Based on record review the Licensee did not comply with the section cited above as 2 resident admission agreements were observed to be missing the rate for basic services which poses a potential personal rights risk to clients in care.
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Type B
08/10/2026
Section Cited
CCR87507(b)

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87507 Admission Agreements
(b) The licensee shall complete... a Telecommunications Device Notification form (LIC 9158, 11/04) for each resident whose...r medical assessment indicates ...hearing-impaired...
This requirement is not met as evidenced by:
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Administrator agreed to complete LIC 9158 forms for the identified residents and to obtain signatures from the residents responsible parties and to submit the completed forms to CCLD no later than POC due date.
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Based on record review the Licensee did not comply with the section cited above as 3 resident files who were identified as having hearing loss were missing the telecommunications Device Notification form which poses a potential personal rights risk to clients 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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Trevor Byrne
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


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: NANA'S DREAM HOUSE FACILITY
FACILITY NUMBER: 197609819
VISIT DATE: 07/27/2026
NARRATIVE
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INTERVIEWS: LPA interviewed one (1) staff and one (1) resident. The resident interviewed stated that staff treat them well and are attentive to their needs. The staff member interview was conducted with the assistance of the Administrator as a translator. The staff member interviewed was knowledgeable on their role and responsibilities, the resident’s rights, the different forms of abuse, and the appropriate reporting procedures for suspected abuse.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
LIC809 (FAS) - (06/04)
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