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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609923
Report Date: 07/22/2026
Date Signed: 07/22/2026 08:31:35 PM

Document Has Been Signed on 07/22/2026 08:31 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:BASSETT RESIDENTIAL CAREFACILITY NUMBER:
197609923
ADMINISTRATOR/
DIRECTOR:		TAVITIAN, HRIPSIMEFACILITY TYPE:
740
ADDRESS:16017 BASSETT STTELEPHONE:
(818) 442-5702
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 6DATE:
07/22/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:16 AM
MET WITH:Laura Hovhannisyan, StaffTIME VISIT/
INSPECTION COMPLETED:
08:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection and used the CARE Inspection Tool to conduct today's visit. LPA Yee initially met with Emma Arutiunian, Administrator but she had prior plans and could not participate in the visit. She contacted Laura Hovhannisyan, Staff to conduct the visit. She arrived at 11:09am to begin 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, a kitchen, a family room, 7 bedrooms of which one is designated as a staff room/Office, a laundry room, 4 full bathrooms. Located behind the laundry room is a single room used by staff. Located in the back is also a storage shed. The facility is fire cleared for 2 AMBULATORY and 4 NON-AMBULATORY.

On today's visit, all 12 domains of the Care Inspection Tool was reviewed, 6 resident and 6 staff files were reviewed and a tour of the entire facility, inside and outside, was inspected. The following was observed:
  • the living room, dining room, kitchen and family room were furnished with the appropriate furniture for its designated used for 6 residents. The fireplace located in the living room did not have a fire screen.
  • all 6 resident bedrooms were furnished with a hospital bed, a night stand, a lamp, a chair, a dresser in bedroom #1, #3, #6 and a built-in closet. No dressers were observed in bedroom #2, #4 and #5. Each room has a wall mounted television. Window dressings were observed. Bedroom #6 has an outside exiting door and no auditory device was observed.
  • continued on LIC809-C
Kristin Heffernan
Christine Yee
DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2026
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 9
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)
Page: 2 of 9
Document Has Been Signed on 07/22/2026 08:31 PM - It Cannot Be Edited


Created By: Christine Yee On 07/22/2026 at 07:11 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: BASSETT RESIDENTIAL CARE
FACILITY NUMBER: 197609923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87608(a)(5)(B)
Postural Supports
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

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 Resident #1's hospital bed was equipped with a full bed rail and they are not on hospice which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/23/2026
Plan of Correction
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Licensee will immediately remove the full bed rails from Resident #1's bed and obtain clarification in writing from the resident's physician indicating the need for the use of the full bedrails. Provide evidence of correction by 7/23/26.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
Page: 6 of 9
Document Has Been Signed on 07/22/2026 08:31 PM - It Cannot Be Edited


Created By: Christine Yee On 07/22/2026 at 07:11 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: BASSETT RESIDENTIAL CARE
FACILITY NUMBER: 197609923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87204(b)
Limitations -Capacity and Ambulatory Status
(b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as per record review, Resident #2 and Resident #6 are determined to be non-ambulatory and were observed housed in bedroom #1 and bedroom #2 which is designated for ambulatory use, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/23/2026
Plan of Correction
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The Licensee will relocate Resident #2 and Resident #6 to rooms approved for non-ambulatory use or submit a written plan or evidence to the Department as to how they will come into compliance with their approved fire clearance by 7/23/26.
Type A
Section Cited
CCR
87307(e)(1)(A)
Personal Accommodations and Services
(e) The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items: (1) Ranges, ovens, heaters, fireplaces, wood stoves, inserts, and other heating devices. (A) Heating devices shall have protective mechanisms or other measures to prevent access to the device, or to make it inoperable when not in use, in order to reduce the risk of burns or fire.

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 that the fire place located in the living room is not made inaccessible to the residents in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/23/2026
Plan of Correction
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Licensee will take steps to make the fireplace inaccessible to the residents in care by putting a barrier to make the fire place inaccessible. A fire screen placed in front of the fire place will meet these requirements. Provide evidence of correction by 7/23/26.
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: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
Page: 5 of 9
Document Has Been Signed on 07/22/2026 08:31 PM - It Cannot Be Edited


Created By: Christine Yee On 07/22/2026 at 07:11 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: BASSETT RESIDENTIAL CARE
FACILITY NUMBER: 197609923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87618(b)(3)(A)
Oxygen Administration - Gas and Liquid
(3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at 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 Resident #!1 was observed using a oxygen concentrator which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/23/2026
Plan of Correction
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Licensee will send a written notification to the local fire department advising them that there is oxygen use at the facility by 7/23/26
Type B
Section Cited
CCR
87618(b)(3)(B)
Oxygen Administration - Gas and Liquid
(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas.

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 there were no signs posted anywhere in the facility to indicate that there is oxygen in use which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/23/2026
Plan of Correction
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The Licensee will ensure that signs reading "No Smoking-Oxygen in Use" are posted in all the appropriate areas by 7/23/26
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: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
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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: BASSETT RESIDENTIAL CARE
FACILITY NUMBER: 197609923
VISIT DATE: 07/22/2026
NARRATIVE
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Page 3.

Deficiencies cited under California Code of Regulations, Tile 22, Division 6, Chapter 8. Civil Penalties were assessed.

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: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC809 (FAS) - (06/04)
Page: 4 of 9
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: BASSETT RESIDENTIAL CARE
FACILITY NUMBER: 197609923
VISIT DATE: 07/22/2026
NARRATIVE
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Page 2.
  • the bed located in bedroom #4 was observed with a full bed rail and the resident is not on hospice. Resident in bedroom #4 was observed on oxygen via a oxygen concentrated and no signs indicating "no smoking, oxygen in use" were posted. Resident #2 and Resident #6 who are determined to be non-ambulatory were observed housed in bedroom #1 and #2 which is for ambulatory use only.
  • All three bathrooms, 2 private bathrooms are equipped with a walk in shower, a sink and a toilet. Slip resistant mats and grab bars were observed in the shower and by the toilet.
  • The water temperature taken in the common bathroom, located by bedroom #2 read 109.9 degrees, the private bathroom between bedroom #3 and #5 read 110.4 degrees and the private bathroom between bedroom #4 and #6 read 112.8 degrees Fahrenheit.
  • Bed linens, blankets and towels were observed in the linen closet.
  • The only fire extinguisher purchased on 3/23/26 is located in the kitchen.
  • The first aid kit containing the required tweezer, scissors, thermometer and dressings and first aid manual was observed.
  • Medications are centrally stored in a locked filing cabinet by the staff room. Sufficient perishable for a minimum of 2 days and non-perishable for a minimum of 7 days was observed maintained on the premises.
  • The facility has hardwired smoke detectors in all the 7 bedrooms and combination smoke/carbon monoxide detectors are located in the resident hallway, family room, in front of bedroom #2. They were operational when tested. The fire rated door located in the resident hallway was operational also.
  • The facility has current general liability insurance with the required Title 22 limits.
  • The laundry room contained a washer and dryer.
  • tables and chairs with umbrellas were observed outside.
  • The facility needs to put away cleaning buckets, mops and roll up hoses.
  • Overall, the facility, inside and outside, were observed to be clean.
  • Licensee will ensure that the roll away bed stored in the family room is removed or picked up as advised.

continued on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 07/22/2026 08:31 PM - It Cannot Be Edited


Created By: Christine Yee On 07/22/2026 at 07:11 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: BASSETT RESIDENTIAL CARE
FACILITY NUMBER: 197609923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87307(a)(3)(B)
Personal Accommodations and Services
(B) Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers.

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 there were no required chest of drawer were observed in bedroom #2, bedroom #4 and bedroom #5 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2026
Plan of Correction
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Licensee will provide a chest of drawers meeting the required 8 cubic feet in bedroom #2, bedroom #4 and bedroom #5 and provide evidence that the deficiency has been corrected by 7/29/26
Type B
Section Cited
HSC
1569.695(a)
Other Provisions
(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the emergencry and disaster plan does not provide sufficient information and questions are simply answered as N/A which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2026
Plan of Correction
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The Licensee will review their Emergency and Disaster Plan to ensure that the plan contains all the Title 22 requirements and provide more details instead of ambigious statments and N/A. Provide evidence of updates by 8/5/26.
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: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
Page: 7 of 9
Document Has Been Signed on 07/22/2026 08:31 PM - It Cannot Be Edited


Created By: Christine Yee On 07/22/2026 at 07:58 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: BASSETT RESIDENTIAL CARE
FACILITY NUMBER: 197609923

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87705(d)
87705 Care of Persons with Dementia
d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, the licensee did not comply with the section cited above as observed during the tour of the bedrooms, that bedroom #6 has an outside exiting door and there is no auditory device mounted on the door to monitor or alert staff when residents who may be at risk for elopment exit, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2026
Plan of Correction
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The Licensee will mount an auditory device on the outside exiting door located in bedroom #6 and provide evidence to the Department by 7/29/26
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
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