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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609829
Report Date: 09/23/2026
Date Signed: 09/23/2026 08:09:15 PM

Document Has Been Signed on 09/23/2026 08:09 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:ARARAT BOARD AND CAREFACILITY NUMBER:
197609829
ADMINISTRATOR/
DIRECTOR:		SARGSYAN, KARINEFACILITY TYPE:
740
ADDRESS:6614 TEESDALE AVETELEPHONE:
(818) 624-4180
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 6CENSUS: 5DATE:
09/23/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:32 AM
MET WITH:Mariam Panadzhyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
08:15 PM
NARRATIVE
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LIcensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and met with Mariam Panadzhyan, Licensee. The reason for today's visit was explained.

The facility is a single storey family home consisting of a living room, dining room, kitchen, 5 bedrooms and 3-1/2 bathrooms. The facility is fire cleared for 5 NON-AMBULATORY residents and 1 BEDRIDDEN resident. Bedroom #1 is designated for bedridden use. Also located on the property is an ADU with a separate address - 6616 Teesdale Avenue. The facility roof is also equipped with solar panels.

On today's visit all 12 domains of the CARE Inspection Tool was reviewed. 5 resident files, 6 staff files and the Emergency Disaster plan was reviewed on today's visit. The following were observed:
  • The dining room, living room and kitchen all have the appropriate furniture and equipment.
  • Sufficient perishable and non-perishable foods were observed in the kitchen and in the back storage building.
  • Located in the kitchen is the first fire extinguisher purchased on 9/3/26
  • Bedroom #1 is a shared room and has 2 beds, 2 chair, 2 night stand, 2 lamps, 2 dressers and a portable closet. The exit door is equipped with a auditory device that was operational. A ramp was observed.
  • Bedroom #2 is a single room furnished with 1 bed , 1 lamp, 1 chair, 1 night stand, a dresser and a built in closet.

continued on LIC809-C
Kristin Heffernan
Christine Yee
DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2026
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 6
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: ARARAT BOARD AND CARE
FACILITY NUMBER: 197609829
VISIT DATE: 09/23/2026
NARRATIVE
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  • Bedroom #3 is a shared room and has 2 beds, 2 night stands, 2 chairs, 2 lamps, 2 dressers and 2 built in closets.
  • Bedroom #4 is a single room furnished with a bed, night stand, lamp, chair, a dresser and portable closet. The blinds on the window are missing many slates and needs to be replaced. Located inside the room is a private bathroom equipped with a large bathtub, a shower stall, a toilet and sink. Grab bars, a shower chair and a slip resistant mat was observed. The water temperature tested 119.0 degrees Fahrenheit. The auditory device on the outside exit glass door was operational.
  • The common bathroom is equipped with a shower, shower chair, grab bars, slip resistance mat. Water temperature was tested and read 118.5 degrees Fahrenheit.
  • The half bathroom located by the back door is equipped with a sink and a toilet. The water temperature read 110.7 degrees Fahrenheit.
  • The office is used solely by staff and contains resident and staff files and centrally stored medications. Located inside the office is a full bathroom.
  • The washing machine and dryer is located inside the kitchen.
  • Extra linens are stored in a cupboard located in the living room
  • The facility has current general liability insurance meeting Title 22 requirements.
  • The first aid kit and first aid manual was observed and met Title 22 requirements.
  • Per tour of the backyard, a table and chairs were observed for resident use. 2 storage rooms for non-perishable foods and incontinence products and PPEs were also observed. On the right side of the house is another storage shed used for storage of wheelchairs and other equipment was observed.
  • Trash cans located in front of the home were observed to be tightly closed.
  • Overall, the inside and the outside of the facility were observed to be well maintained.


Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8.

Exit interview was conducted, Appeals Rights were discussed and a copy was provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/23/2026 08:09 PM - It Cannot Be Edited


Created By: Christine Yee On 09/23/2026 at 07:09 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: ARARAT BOARD AND CARE
FACILITY NUMBER: 197609829

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as it was observed,per tour of the facility i that the blinds on the window located in bedroom #4 are missing slates and needs to be replaced to allow for privacy, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2026
Plan of Correction
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The Licensee will ensure that the blinds in all the bedrooms are inspected and to ensure that they are in good condition or replace them as needed, especially the blinds in Bedroom #4 by 9/30/26
Type B
Section Cited
HSC
1569.618(a)
Other Provisions: (a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as it was observed that the facility administrator holds a full time job as a registered nurse and has never been observed at the facility and is not available during business hours, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2026
Plan of Correction
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The Licensee will submit a written plan of action as to how she will ensure that the designated administrator is present during business hours to ensure that she/he is present to participate in the operations of the facility during business hours with licensing and available to conduct visits with familiies if needed. Provide a copy of the written plan of action by 9/30/26
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:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/23/2026 08:09 PM - It Cannot Be Edited


Created By: Christine Yee On 09/23/2026 at 07:25 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: ARARAT BOARD AND CARE
FACILITY NUMBER: 197609829

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(b)
87465(b) Incidental Medical and Dental Care Services
(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 1 out 5 counts that Resident #3 has PRN Lorezapam but there is no written PRN Authorization letter on file. PRN medications are dispensed daily by staff without contact with the prescribing doctor, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2026
Plan of Correction
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The Licensee will contact the prescribing doctor to obtain a PRN Authorization Letter for Resident #3's PRN Lorezapam and any PRN medications prescribed for Resident #3 or for any other resident by 9/30/26
Type B
Section Cited
CCR
87463(a)
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above as per record review it was observed that Residents #2 and Resident #3 do not have current reappraisals on file. The last appraisal for Resident #2 was on 4/21/21 and last appraisal for Resident #3 was on 7/28/24. in [count] out of [total count] [(objects) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2026
Plan of Correction
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The Licensee will schedule an appointment with the family and Resdient #2 and Resident #3 to conduct an annual an annual appraisal to ensure that any changes in the residents' care is documented and addressed in their care plan. Licensee will submit a copy of the updated care plan to the Department by 9/30/26.
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:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2026


LIC809 (FAS) - (06/04)
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